The effect of insurance status on overall survival among children and adolescents with cancer

• Published in: International journal of epidemiology 2020-08, Vol.49 (4), p.1366-1377
• Main Authors: Wang, Xiaoyan, Ojha, Rohit P, Partap, Sonia, Johnson, Kimberly J
• Format: Article
• Language: English
• Subjects: Adolescent; Aged; Child; Humans; Insurance Coverage; Insurance, Health; Medicaid; Medically Uninsured; Neoplasms - therapy; United States - epidemiology
• ISSN: 0300-5771; 1464-3685
• DOI: 10.1093/ije/dyaa079

Abstract Background Differences in access, delivery and utilisation of health care may impact childhood and adolescent cancer survival. We evaluated whether insurance coverage impacts survival among US children and adolescents with cancer diagnoses, overall and by age group, and explored potential mechanisms. Methods Data from 58 421 children (aged ≤14 years) and adolescents (15–19 years), diagnosed with cancer from 2004 to 2010, were obtained from the National Cancer Database. We examined associations between insurance status at initial diagnosis or treatment and diagnosis stage; any treatment received; and mortality using logistic regression, Cox proportional hazards (PH) regression, restricted mean survival time (RMST) and mediation analyses. Results Relative to privately insured individuals, the hazard of death (all-cause) was increased and survival months were decreased in those with Medicaid [hazard ratio (HR) = 1.27, 95% confidence interval (CI): 1.22 to 1.33; and −1.73 months, 95% CI: −2.07 to −1.38] and no insurance (HR = 1.32, 95% CI: 1.20 to 1.46; and −2.13 months, 95% CI: −2.91 to −1.34). The HR for Medicaid vs. private insurance was larger (pinteraction