Not having insurance reduces the chance that someone with colorectal cancer will live a year after their diagnosis. Even when patients from 18 to 64 have other illnesses, their insurance status makes a difference in survival.
Risk of dying during that first year was 50 to 90 percent higher among the uninsured. They were more likely to diagnosed at an advanced stage and live in poor neighborhoods.
Other illness (comorbidities) was lowest in privately insured patients and highest in patients under 65 on Medicare, who were likely to have Medicare because of a disability.
Trying to track down reasons for why uninsured colorectal cancer patients have poorer survival, researchers at the American Cancer Society in Atlanta analyzed information for nearly 65,000 patients with colorectal cancer in the National Cancer Data Base in years 2003 through 2005. In addition to cancer information, they studied comorbidities to see if they were contributing to increased deaths.
After adjusting statistics for factors known to affect survival including age, stage at diagnosis, where patients were treated, and neighborhood education level and income, risk of dying was significantly higher for all patients without private insurance—78% higher for uninsured patients, 64% higher for those insured by Medicaid, and 86% higher for those insured by Medicare.
However, although patients who were uninsured or who had Medicaid or Medicare had more comorbidities than patients with private insurance, that difference didn’t have an impact once insurance status was figured in.
Anthony S. Robbins, MD, PhD and his colleagues in the Department of Surveillance and Health Policy Research at theAmerican Cancer Society in Atlanta concluded,
Thus, using data from more than 64,000 colorectal cancer patients in a large national database, we found substantial differences in comorbidity level by insurance status, but these differences did not explain the poorer survival of patients without private insurance. Even after adjustment for age, stage, facility type, neighborhood education level and income, and number of comorbid conditions, whites and blacks without private insurance had 40% to 80% higher risk of death during the first year after diagnosis. These higher death rates translated into large reductions in 1-year survival for patients without private insurance and those with higher comorbidity levels.
SOURCE: Robbins et al.,Journal of Clinical Oncology,Volume 27, Number 22, August 1, 2009.