Association of Tumor Characteristics With Insurance Type Among Patients Undergoing Mohs Micrographic Surgery for Nonmelanoma Skin Cancer.

Autor:	Clarke EL; Division of Dermatology, Department of Internal Medicine, Dell Medical School at The University of Texas at Austin., Willenbrink TJ; Zitelli and Brodland Skin Cancer Center, Pittsburgh, Pennsylvania., Shelton M; University of Michigan School of Medicine, Department of Dermatology, Ann Arbor., Naeem A; Division of Dermatology, Department of Internal Medicine, Dell Medical School at The University of Texas at Austin.; The Warren Alpert Medical School at Brown University, Providence, Rhode Island., Custer J; Department of Population Health, Dell Medical School at The University of Texas at Austin., Lundgren AD; Dermatology Specialists of Spokane, Spokane, Washington., Boothe WD; Texas Tech Health Sciences Center, Department of Dermatology, Lubbock., Rathouz PJ; Department of Population Health, Dell Medical School at The University of Texas at Austin., Adamson AS; Division of Dermatology, Department of Internal Medicine, Dell Medical School at The University of Texas at Austin., Fox MC; Division of Dermatology, Department of Internal Medicine, Dell Medical School at The University of Texas at Austin., Jambusaria-Pahlajani A; Division of Dermatology, Department of Internal Medicine, Dell Medical School at The University of Texas at Austin.
Jazyk:	angličtina
Zdroj:	JAMA dermatology [JAMA Dermatol] 2022 Aug 01; Vol. 158 (8), pp. 919-922.
DOI:	10.1001/jamadermatol.2022.1802
Abstrakt:	Importance: Little is known about the association between insurance type and tumor or treatment characteristics among patients undergoing Mohs micrographic surgery (MMS) for nonmelanoma skin cancer (NMSC). Objective: To investigate whether there are differences in tumor and treatment characteristics among patients undergoing MMS for NMSC by insurance type. Design, Setting, and Participants: This retrospective cohort study included patients with NMSC who presented for surgery at an academic MMS practice between May 2017 and May 2019. Main Outcomes and Measures: Preoperative and postoperative tumor diameters, number of MMS stages, type of closure, and number of high-risk tumors were compared based on insurance type among uninsured and underinsured patients and those with private insurance, Medicare, and Veterans Affairs (VA) insurance. Results: A total of 1397 patients with NMSC (978 [70%] male; mean [SD] age, 68.5 [12.4] years) underwent 1916 MMS procedures. Of these patients, 868 (45%) had Medicare, 570 (30%) had private insurance, 299 (16%) had VA insurance, and 179 (9%) were treated at a safety net clinic or were uninsured. Compared with patients with private insurance, uninsured and underinsured patients had significantly larger preoperative tumor bed diameters (difference, 28%; 95% CI, 14%-43%; P < .001) and postoperative defect sizes (difference, 28%, 95% CI, 16%-41%; P < .001). Patients with Medicare and VA insurance did not have significantly different preoperative tumor bed diameters compared with patients with private insurance. Patients with VA insurance had larger postoperative defect sizes than patients with private insurance (difference, 12%; 95% CI, 2%-23%; P = .02). The number of MMS stages and type of closure did not significantly differ based on insurance type. Conclusions and Relevance: In this cohort study of patients undergoing MMS for NMSC, larger preoperative tumor and postoperative defect sizes were associated with being uninsured or underinsured compared with privately insured. Future studies are required to determine why these differences exist to deliver optimal care to all patients.
Databáze:	MEDLINE
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