Association of health insurance with outcomes in adults ages 18 to 64 years with melanoma in the United States - 15/01/16
Abstract |
Background |
Studies evaluating insurance status and melanoma outcomes are limited.
Objective |
We investigated whether health insurance correlates with more advanced disease, receipt of treatment, and survival in melanoma.
Methods |
This was a cross-sectional analysis of 61,650 patients with cutaneous melanoma using the Surveillance, Epidemiology, and End Results database.
Results |
Under multivariate analysis, patients with either Medicaid insurance (hazard ratio, 1.83; 95% confidence interval [CI], 1.65-2.04; P < .001) or uninsured status (hazard ratio, 1.63; 95% CI, 1.44-1.85; P < .001) were more likely to die of any cause, including melanoma. Uninsured compared with non-Medicaid insured cases more often presented with increasing tumor thickness (odds ratio [OR], 2.19; 95% CI, 1.76-2.73; P < .001) and presence of ulceration (OR, 1.64; 95% CI, 1.40-1.92; P < .001), and less often received treatment (OR, 1.87; 95% CI, 1.60-2.19; P < .001). Compared with non-Medicaid insured, Medicaid cases more often had increasing tumor thickness (OR, 2.36; 95% CI, 1.91-2.91; P < .001), advanced stage (OR, 1.59; 95% CI, 1.37-1.85; P < .001), and presence of ulceration (OR, 1.40; 95% CI, 1.19-1.63; P < .001), and less often received treatment (OR, 1.61; 95% CI, 1.37-1.89; P < .001).
Limitations |
This was a retrospective study.
Conclusion |
Patients with melanoma and Medicaid or uninsured status were more likely to present with advanced disease and were less likely to receive treatment, likely contributing to an overall and cause-specific survival detriment. Addressing access to care may help improve these outcomes.
Le texte complet de cet article est disponible en PDF.Key words : Affordable Care Act, health care disparities, health insurance, malignant melanoma, treatment outcomes
Abbreviations used : CI, CSS, HR, OR, OS, SEER, SES
Plan
| Funding sources: None. |
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| Conflicts of interest: None declared. |
Vol 74 - N° 2
P. 309-316 - février 2016 Retour au numéro
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