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The Effect of Health Insurance on Pediatric Cancer Survival: An Analysis of Children Evaluated for Radiation Therapy
Jessica R Fine1, Justine M Ransdell1, Paulo S Pinheiro2,3
1University of Miami Miller School of Medicine.
Insights
Children with Medicaid/Medicare insurance had worse cancer survival outcomes. This study highlights disparities in pediatric radiation oncology care, emphasizing the need for equitable insurance coverage for better recurrence-free survival (RFS) and overall survival (OS).
Area of Science:
- Pediatric Oncology
- Health Services Research
- Radiation Oncology
Background:
- Health insurance plays a crucial role in cancer survival, particularly in diverse pediatric populations undergoing radiation therapy.
- Identifying patients at risk of adverse outcomes is essential for improving care in pediatric radiation oncology.
Purpose of the Study:
- To investigate the impact of health insurance type on cancer survival among pediatric patients receiving radiation therapy.
- To identify potential disparities in recurrence-free survival (RFS) and overall survival (OS) based on insurance status.
Main Methods:
- Analysis of data from 459 pediatric patients (<19 years) diagnosed between 1990 and 2019, evaluated for radiation therapy.
- Univariable and multivariable Cox regression models were used to analyze predictors of RFS and OS, including health insurance, diagnosis type, sex, race/ethnicity, and socioeconomic status.
- Key variables included private pay insurance versus Medicaid/Medicare.
Main Results:
- Patients with Medicaid/Medicare insurance showed significantly lower 5-year RFS (36.5%) and OS (71.0%) compared to privately insured patients (59.8% RFS, 87.5% OS).
- Multivariable analysis revealed that Medicaid/Medicare patients had a 54% higher risk of recurrence and a 79% higher risk of death.
- These disparities persisted even after adjusting for clinical and demographic factors.
Conclusions:
- Pediatric radiation oncology patients with Medicaid/Medicare insurance face significant disadvantages in both recurrence-free survival and overall survival.
- Insurance status is a critical factor influencing outcomes in pediatric cancer care, independent of other clinical and demographic variables.
- Findings underscore the need to address insurance-related barriers to optimize cancer care and survival for all pediatric patients.
Background:
Understanding the role of health insurance in cancer survival in a diverse population of pediatric radiation oncology patients could help to identify patients at risk of adverse outcomes.
Materials And Methods:
Data were collected from cancer patients evaluated for radiation therapy, age < 19, diagnosed from January 1990 to August 2019. Predictors of recurrence-free survival (RFS) and overall survival (OS) were analyzed by univariable and multivariable Cox regression. Variables included health insurance, diagnosis type, sex, race/ethnicity, and socioeconomic status deprivation index.
Results:
The study included 459 patients with a median diagnosis age of 9 years. Demographic breakdown was 49.5% Hispanic, 27.2% non-Hispanic White, and 20.7% non-Hispanic Black. There were 203 recurrences and 86 deaths observed over a median follow-up of 2.4 years. Five-year RFS was 59.8% (95% CI, 51.6, 67.0) versus 36.5% (95% CI, 26.6, 46.6), and 5-year OS was 87.5% (95% CI, 80.9, 91.9) versus 71.0% (95% CI, 60.3, 79.3) in private pay insurance versus Medicaid/Medicare, respectively. Multivariable showed Medicaid/Medicare patients experienced a 54% higher risk of recurrence (hazard ratio: 1.54, 95% CI, 1.08, 2.20) and 79% higher risk of death (hazard ratio: 1.79, 95% CI, 1.02, 3.14) than privately insured patients.
Conclusions:
Significant disadvantages in RFS and OS were identified in radiation oncology patients with Medicaid/Medicare insurance, even after adjusting for clinical and demographic variables.
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