Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research
| Autor: | Joan M. Neuner, Manali I. Patel, Leon Bernal-Mizrachi, Michael T. Halpern, Jonathan K. Phillips, Ana Maria Lopez, William Blackstock, K. Robin Yabroff, Katherine E. Reeder-Hayes, Jingxuan Zhao, Anderson B. Collier |
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| Rok vydání: | 2020 |
| Předmět: |
Cancer Research
medicine.medical_specialty business.industry Clinical study design Hazard ratio Cancer Odds ratio medicine.disease 03 medical and health sciences 0302 clinical medicine Oncology 030220 oncology & carcinogenesis Emergency medicine Patient Protection and Affordable Care Act medicine Observational study 030212 general & internal medicine business Medicaid End-of-life care |
| Zdroj: | JNCI: Journal of the National Cancer Institute. 112:671-687 |
| ISSN: | 1460-2105 0027-8874 |
| DOI: | 10.1093/jnci/djaa048 |
| Popis: | Background Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. Methods We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. Results Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. Conclusions Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes. |
| Databáze: | OpenAIRE |
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