Insurance status is related to diffuse large B-cell lymphoma survival

Abstract

Background: Insurance status is associated with stage at diagnosis and treatment for non-Hodgkin lymphoma (NHL), but no previous studies have addressed the relation between insurance status and survival for patients diagnosed with diffuse large B-cell lymphoma (DLBCL), the most common subtype of NHL.

Methods: The authors analyzed survival among 3858 patients with DLBCL ages 18 to 64 years who were diagnosed in 2004 using data from the National Cancer Database, a nationwide, hospital-based cancer registry. Kaplan-Maier curves were compared between patients who had private insurance, Medicaid, and no insurance. Cox proportional hazards models were fitted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for insurance controlling for age, sex, race, area-level socioeconomic status, and potential mediators of the association between insurance status and survival, including stage at diagnosis, B-symptoms, comorbidity, and treatment.

Results: After adjusting for sociodemographic factors, uninsured patients (HR, 1.39; 95% CI, 1.14-1.70) and Medicaid-insured patients (HR, 1.48; 95% CI, 1.23-1.78) with DLBCL had lower survival compared with patients who had private insurance. This association was attenuated after adjusting for the potential mediators (for uninsured patients, HR, 1.18 [95% CI, 0.96-1.44]; for Medicaid-insured patients, HR, 1.27 [95% CI, 1.06-1.53]).

Conclusions: Uninsured and Medicaid-insured patients with DLBCL had inferior survival compared with privately insured patients. These associations can be explained in part because uninsured/Medicaid-insured patients who have DLBCL present with more advanced-stage disease and comorbid illnesses and less commonly receive standard treatment. Access to affordable and adequate health care has the potential to improve survival for patients with DLBCL.

Keywords: chemoimmunotherapy; comorbidity; diffuse large B-cell lymphoma; insurance; stage; survival.