Health insurance and stage at diagnosis of laryngeal cancer: Does insurance type predict stage at diagnosis?

Amy Y. Chen, Nicole M. Schrag, Michael Halpern, Andrew Stewart, Elizabeth M. Ward

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Objective: To examine whether patients with no insurance or Medicaid are more likely to present with advanced-stage laryngeal cancer. Design: Retrospective cohort study from the National Cancer Database, 1996-2003. Setting: Hospital-based practice. Participants: Patients with known insurance status diagnosed as having invasive laryngeal cancer at Commission on Cancer facilities (N=61 131) were included. Adjusted and unadjusted logistic regression models analyzed the likelihood of presenting at a more advanced stage. Main Outcome Measures: Overall stage of laryngeal cancer (early vs advanced) and tumor size (T stage) at diagnosis. Results: Patients with advanced-stage laryngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.79-2.15) or covered by Medicaid (OR, 2.40; 95% CI, 2.21-2.61) compared with those with private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.92; 95% CI, 2.60-3.28) or covered by Medicaid (OR, 3.97; 95% CI, 3.56-4.34). Patients who were black, between ages 18 and 56 years, and who resided in zip codes with low proportions of high school graduates or low median household incomes were also more likely to be diagnosed as having advanced disease and/or larger tumors. Conclusions: Individuals lacking insurance or having Medicaid are at greatest risk for presenting with advanced laryngeal cancer. Results for the Medicaid group may be influenced by the postdiagnosis enrollment of uninsured patients. It is important to consider the impact of insurance coverage on stage at diagnosis and associated morbidity, mortality, quality of life, and costs.

Original languageEnglish (US)
Pages (from-to)784-790
Number of pages7
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume133
Issue number8
DOIs
StatePublished - Aug 2007
Externally publishedYes

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Laryngeal Neoplasms
Health Insurance
Insurance
Medicaid
Odds Ratio
Confidence Intervals
Insurance Coverage
Neoplasms
Logistic Models
Cohort Studies
Retrospective Studies
Quality of Life
Outcome Assessment (Health Care)
Databases
Morbidity
Costs and Cost Analysis
Mortality

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Health insurance and stage at diagnosis of laryngeal cancer : Does insurance type predict stage at diagnosis? / Chen, Amy Y.; Schrag, Nicole M.; Halpern, Michael; Stewart, Andrew; Ward, Elizabeth M.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 133, No. 8, 08.2007, p. 784-790.

Research output: Contribution to journalArticle

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abstract = "Objective: To examine whether patients with no insurance or Medicaid are more likely to present with advanced-stage laryngeal cancer. Design: Retrospective cohort study from the National Cancer Database, 1996-2003. Setting: Hospital-based practice. Participants: Patients with known insurance status diagnosed as having invasive laryngeal cancer at Commission on Cancer facilities (N=61 131) were included. Adjusted and unadjusted logistic regression models analyzed the likelihood of presenting at a more advanced stage. Main Outcome Measures: Overall stage of laryngeal cancer (early vs advanced) and tumor size (T stage) at diagnosis. Results: Patients with advanced-stage laryngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.97; 95{\%} confidence interval [CI], 1.79-2.15) or covered by Medicaid (OR, 2.40; 95{\%} CI, 2.21-2.61) compared with those with private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.92; 95{\%} CI, 2.60-3.28) or covered by Medicaid (OR, 3.97; 95{\%} CI, 3.56-4.34). Patients who were black, between ages 18 and 56 years, and who resided in zip codes with low proportions of high school graduates or low median household incomes were also more likely to be diagnosed as having advanced disease and/or larger tumors. Conclusions: Individuals lacking insurance or having Medicaid are at greatest risk for presenting with advanced laryngeal cancer. Results for the Medicaid group may be influenced by the postdiagnosis enrollment of uninsured patients. It is important to consider the impact of insurance coverage on stage at diagnosis and associated morbidity, mortality, quality of life, and costs.",
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