A new report by a major US cancer charity has found that uninsured Americans are less likely to survive cancer, less likely to be screened for it, and more
likely to have an advanced stage of the disease once they are diagnosed, compared with Americans on health insurance.
The study, which examines the link between health insurance status and cancer treatment and survival, will appear in the January-February edition of the journal CA: A Cancer Journal for Clinicians and is the work of researchers from the American Cancer Society (ACS), led by Dr Elizabeth Ward, managing director, surveillance research at the ACS.
Other studies have already suggested that Medicaid and uninsured patients are more likely to be diagnosed with cancers that are more advanced, mostly because they can't afford to buy preventative services such as cancer screening.
This report from the ACS takes a closer look at the link between insurance status and cancer care, and takes into account a number of demographic, race, and socioeconomic factors.
Dr Otis Brawley, chief medical officer of the American Cancer Society, said:
"This report clearly suggests that insurance and cost-related barriers to care are critical to address if we want to ensure that all Americans are able to share in the progress we have achieved by having access to high-quality cancer prevention, early detection, and treatment services."
Ward and colleagues looked at data from 598,635 cases in the National Cancer Data Base (NCDB). The NCDB is held by the ACS and collects data from 1,500 hospital registers. It tracks about 70 per cent of the cancer cases in the US.
They also included information from the 2005 and 2006 National Health Interview Survey (NHIS), which covers about 40,000 American households and is carried out by the National Center for Health Statistics (NCHS) of the US Centers for Disease Control and Prevention (CDC).
The patients in the sample were either privately insured, covered by Medicaid (the government scheme for individuals and families on low incomes), or not insured at all.
The results showed that:
- Patients on lower incomes were less likely to have insurance.
- Patients without insurance were less likely to use certain health services.
- For all cancers, uninsured patients were 1.6 times more likely to die within 5 years than individuals with private insurance.
- About 54 per cent of patients aged 18 to 64 without insurance did not have a usual source of health care.
- Nearly 23 per cent of patients without insurance did not get care because of the cost.
- About 26 per cent of patients without insurance delayed care because of the cost.
- About 23 per cent did not get prescription drugs because of the cost.
- Patients with health insurance were twice as likely to have had a recent mammogram or screening for colorectal cancer, compared to the uninsured.
- Regardless of race or ethnicity, women without health insurance were half as likely to have had a mammogram in the last two years compared with women who were insured.
- About 48 per cent of insured adults aged 50 to 64 underwent colorectal cancer screening compared with 19 per cent uninsured.
- Insured patients were more likely to have been diagnosed early and less likely to have an advanced cancer diagnosis compared with uninsured patients.
- About 89 per cent of insured white women with breast cancer survived at least 5 years.
- This compared with 76 per cent of white women on Medicaid or no insurance.
- About 81 per cent of African-American women with breast cancer survived at least 5 years.
- This compared with 65 per cent of African-American women on Medicaid and 63 per cent of those with no insurance.
- There was a similar pattern for colorectal cancer.
"For too many hardworking 'average Americans' paying for cancer treatment means not paying rent, mortgage (resulting in foreclosure or eviction), or utility bills, or even going
The report found that the risk of being uninsured or underinsured varied. Adults from 18 to 24 years of age were the most likely to be uninsured, and non-Hispanic whites were more likely to be insured compared to African Americans, Hispanics, Asian American/Pacific Islanders, and American Indian/Alaska Natives.
Ward said of their findings:
"It's important to note that although variations in health insurance coverage likely contribute to racial and ethnic disparities in cancer outcomes, those disparities persist for several outcomes even when differences in insurance status are accounted for."
"So even if health insurance and financial barriers can be overcome, further research and interventions will be needed to address these other barriers," she explained.
"Association of Insurance with Cancer Care Utilization and Outcomes."
Elizabeth Ward, American Cancer Society, et al.
CA: A Cancer Journal for Clinicians, Printed issue: Jan/Feb 2008 (Vol. 58, No.1).
Early Online issue not yet available.
Click here for journal website.
Source: ACS website.
Written by: Catharine Paddock