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. 2010 Jan 15;116(2):476-85.
doi: 10.1002/cncr.24774.

The impact of health insurance status on the survival of patients with head and neck cancer

Joseph Kwok  1 , Scott M Langevin, Athanassios Argiris, Jennifer R Grandis, William E Gooding, Emanuela Taioli
Affiliations

The impact of health insurance status on the survival of patients with head and neck cancer

Joseph Kwok et al. Cancer. .

Abstract

Background: In 2006, it was estimated that 47 million people in the United States are without insurance. Studies have shown that patients who are uninsured or are insured by Medicaid are more likely to present with more advanced cancer. The objective of this study was to examine whether cancer recurrence and mortality of patients diagnosed with squamous cell carcinoma of the head and neck are associated with insurance status, after adjusting for known cancer risk factors. The main outcome measures were overall survival and relapse-free survival.

Methods: Retrospective cohort of patients with a biopsy-proven primary squamous cell carcinoma of the oral cavity, pharynx, or larynx diagnosed or treated at the University of Pittsburgh Medical Center between 1998 and 2007. Patients were stratified by their insurance status, including private insurance, uninsured/Medicaid, Medicare disability (Medicare under age 65), and Medicare 65 years + . Covariates included age, gender, race, smoking status, alcohol consumption, anatomic tumor site, treatment, stage at diagnosis, and occupational prestige score. Cox proportional hazards regression was used to estimate the effect of insurance status on overall survival, relapse-free survival, tumor stage, and lymph node involvement.

Results: A total of 1231 patients were included in the analysis. Patients with Medicaid/uninsured (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.07-2.11) and Medicare disability (HR, 1.69; 95% CI, 1.16-2.48) had significantly lower overall survival compared with patients with private insurance; the result was independent of variables known to affect outcome, such as alcohol and tobacco use. For all squamous cell carcinoma of the head and neck (SCCHN) cancer sites, Medicaid and uninsured patients were significantly more likely to present with an advanced stage tumor at diagnosis (odds ratio [OR] = 2.94; 95% CI, 1.72-5.01) and to present with at least 1 positive lymph node (OR = 1.84; 95% CI, 1.16-2.90) compared with patients with private insurance.

Conclusions: Patients with Medicaid/uninsured and Medicare disability were at increased risk of death after a diagnosis of SCCHN when compared with patients with private insurance, after adjustment for age, gender, race, smoking, alcohol use, site, socioeconomic status, treatment, and cancer stage.

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Figures

Figure 1
Figure 1
Definition of the cohort under study is depicted. aIncludes Veterans Affairs (n = 10) and Indian Health Service (n = 2).
Figure 2
Figure 2
Presented is age-adjusted survival according to insurance status, all-cause mortality. P is based on the log-rank test across insurance categories.
Figure 3
Figure 3
Presented is age-adjusted relapse-free survival according to insurance status. P is based on the log-rank test across insurance categories.
See this image and copyright information in PMC

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