Insurance impacts survival for children, adolescents, and young adults with bone and soft tissue sarcomas

Autor: Lena E. Winestone, Stephen Shiboski, Patricia Murphy, Robert E. Goldsby, Rosanna Wustrack, Neela L. Penumarthy
Jazyk: angličtina
Rok vydání: 2019
Předmět:
0301 basic medicine
Male
Cancer Research
sarcoma
AYA
Disease
Kaplan-Meier Estimate
Health Services Accessibility
Insurance Coverage
0302 clinical medicine
Medicine
Young adult
Stage (cooking)
Child
Cancer
Original Research
Pediatric
Osteosarcoma
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
3. Good health
Oncology
030220 oncology & carcinogenesis
Child
Preschool
health insurance
Income
Female
Sarcoma
Adult
medicine.medical_specialty
pediatrics
Adolescent
Oncology and Carcinogenesis
Bone Neoplasms
lcsh:RC254-282
03 medical and health sciences
Young Adult
cancer disparities
Clinical Research
Internal medicine
Humans
Radiology
Nuclear Medicine and imaging
Preschool
Survival analysis
Neoplasm Staging
Retrospective Studies
business.industry
Proportional hazards model
Medicaid
Infant
Newborn
Clinical Cancer Research
Infant
Health Status Disparities
Newborn
medicine.disease
United States
Cancer registry
Good Health and Well Being
030104 developmental biology
Biochemistry and Cell Biology
business
SEER Program
Zdroj: Cancer Medicine
Cancer medicine, vol 9, iss 3
Cancer Medicine, Vol 9, Iss 3, Pp 951-958 (2020)
ISSN: 2045-7634
Popis: Background While racial/ethnic survival disparities have been described in pediatric oncology, the impact of income has not been extensively explored. We analyzed how public insurance influences 5‐year overall survival (OS) in young patients with sarcomas. Methods The University of California San Francisco Cancer Registry was used to identify patients aged 0‐39 diagnosed with bone or soft tissue sarcomas between 2000 and 2015. Low‐income patients were defined as those with no insurance or Medicaid, a means‐tested form of public insurance. Survival curves were computed using the Kaplan‐Meier method and compared using log‐rank tests and Cox models. Causal mediation was used to assess whether the association between public insurance and mortality is mediated by metastatic disease. Results Of 1106 patients, 39% patients were classified as low‐income. Low‐income patients were more likely to be racial/ethnic minorities and to present with metastatic disease (OR 1.96, 95% CI 1.35‐2.86). Low‐income patients had significantly worse OS (61% vs 71%). Age at diagnosis and extent of disease at diagnosis were also independent predictors of OS. When stratified by extent of disease, low‐income patients consistently had significantly worse OS (localized: 78% vs 84%, regional: 64% vs 73%, metastatic: 23% vs 30%, respectively). Mediation analysis indicated that metastatic disease at diagnosis mediated 15% of the effect of public insurance on OS. Conclusions Low‐income patients with bone and soft tissue sarcomas had decreased OS regardless of disease stage at presentation. The mechanism by which insurance status impacts survival requires additional investigation, but may be through reduced access to care.
Low‐income patients with bone and soft tissue sarcomas had decreased overall survival compared to patients with private insurance regardless of disease stage at presentation. This survival disparity is partially mediated by presentation with advanced disease.
Databáze: OpenAIRE
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