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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Cancer Surveillance Research

Relationship between Insurance Type at Diagnosis and Hepatocellular Carcinoma Survival

Shoshana Adler Jaffe, Orrin Myers, Angela L.W. Meisner, Charles L. Wiggins, Deirdre A. Hill and Jean A. McDougall
Shoshana Adler Jaffe
1University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.
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  • For correspondence: sadlerjaffe@salud.unm.edu
Orrin Myers
2Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico.
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  • ORCID record for Orrin Myers
Angela L.W. Meisner
1University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.
3New Mexico Tumor Registry, Albuquerque, New Mexico.
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Charles L. Wiggins
1University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.
3New Mexico Tumor Registry, Albuquerque, New Mexico.
4Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.
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Deirdre A. Hill
4Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.
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Jean A. McDougall
1University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.
4Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.
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DOI: 10.1158/1055-9965.EPI-19-0902 Published February 2020
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Abstract

Background: For individuals with hepatocellular carcinoma (HCC), type of insurance may be an important prognostic factor because of its impact on access to care. This study investigates the relationship between insurance type at diagnosis and stage-specific survival.

Methods: This retrospective cohort analysis used data from 18 Surveillance, Epidemiology, and End Results Program cancer registries. Individuals ages 20 to 64 years, diagnosed with primary HCC between 2010 and 2015, with either private, Medicaid, or no insurance were eligible for cohort inclusion. Adjusted Cox proportional-hazards regression models were used to generate HRs and 95% confidence intervals (CI) for associations between insurance type at diagnosis and overall survival. All models were stratified by stage at diagnosis.

Results: This analysis included 14,655 cases. Compared with privately insured individuals with the same stage of disease, those with Medicaid had a 43% (HR = 1.43; 95% CI, 1.13–1.32), 22% (HR = 1.22; 95% CI, 1.13–1.32), and 7% higher risk of death for localized, regional, and distant stage, respectively. Uninsured individuals had an 88% (HR = 1.88; 95% CI, 1.65–2.14), 59% (HR = 1.59; 95% CI, 1.41–1.80), and 35% (HR = 1.35; 95% CI, 1.18–1.55) higher risk of death for localized, regional, and distant stage, respectively, compared with privately insured individuals.

Conclusions: Disparities in survival exist by the type of insurance that individuals with HCC have at the time of diagnosis.

Impact: These findings support the need for additional research on access to and quality of cancer care for Medicaid and uninsured patients.

Footnotes

  • Cancer Epidemiol Biomarkers Prev 2020;29:300–7

  • Received July 31, 2019.
  • Revision received October 1, 2019.
  • Accepted November 26, 2019.
  • Published first December 3, 2019.
  • ©2019 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 29 (2)
February 2020
Volume 29, Issue 2
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Relationship between Insurance Type at Diagnosis and Hepatocellular Carcinoma Survival
Shoshana Adler Jaffe, Orrin Myers, Angela L.W. Meisner, Charles L. Wiggins, Deirdre A. Hill and Jean A. McDougall
Cancer Epidemiol Biomarkers Prev February 1 2020 (29) (2) 300-307; DOI: 10.1158/1055-9965.EPI-19-0902

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Relationship between Insurance Type at Diagnosis and Hepatocellular Carcinoma Survival
Shoshana Adler Jaffe, Orrin Myers, Angela L.W. Meisner, Charles L. Wiggins, Deirdre A. Hill and Jean A. McDougall
Cancer Epidemiol Biomarkers Prev February 1 2020 (29) (2) 300-307; DOI: 10.1158/1055-9965.EPI-19-0902
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