The impact of health insurance status on stage at diagnosis of oropharyngeal cancer

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

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

BACKGROUND. Although patients who have early-stage oropharyngeal cancer can be treated with little impairment of function, the treatment of advanced disease can result in decreased quality of life and mortality. Patients without insurance and with other barriers to access to care may delay seeking medical attention for early symptoms, resulting in more advanced disease at presentation. In this study, the authors examined whether patients who had no insurance or who were covered by Medicaid insurance were more likely to present with advanced oropharyngeal cancer. METHODS. In this retrospective cohort study from the National Cancer Database from 1996 to 2003, patients with known insurance status who were diagnosed with invasive oropharyngeal cancer at Commission on Cancer facilities (n = 40,487) were included. Adjusted and unadjusted logistic regression models were used to analyze the likelihood of presenting with more advanced stage disease. RESULTS. After controlling for other sociodemographic characteristics, patients with advanced oropharyngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.37; 95% confidence interval [95% CI], 1.21-1.25) or covered by Medicaid (OR, 1.31; 95% CI, 1.19-1.46) compared with patients who had private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.82; 95% CI, 2.46-3.23) or covered by Medicaid (OR, 2.95; 95% CI, 2.63-3.31). They also were more likely to present with the greatest degree of lymph node involvement (N3) if they were uninsured (OR, 2.06; 95% CI, 1.76-2.40) or covered by Medicaid (OR, 1.66; 95% CI, 1.45-1.90). CONCLUSIONS. Individuals who lacked insurance or had Medicaid coverage were at the greatest risk for presenting with advanced oropharyngeal cancer. In the current study, the results for the Medicaid group may have been influenced by the postdiagnostic enrollment of uninsured patients. Insurance coverage appeared to be a highly modifiable predictor of cancer stage. The findings indicated that it is important to consider the impact of insurance coverage on disease stage at diagnosis and associated morbidity, mortality, and quality of life.

Original languageEnglish (US)
Pages (from-to)395-402
Number of pages8
JournalCancer
Volume110
Issue number2
DOIs
StatePublished - Jul 15 2007
Externally publishedYes

Fingerprint

Oropharyngeal Neoplasms
Insurance Coverage
Health Insurance
Health Status
Medicaid
Insurance
Odds Ratio
Confidence Intervals
Neoplasms
Logistic Models
Quality of Life
Mortality
Cohort Studies
Retrospective Studies
Lymph Nodes
Databases
Morbidity

Keywords

  • Access to care
  • Commission on Cancer
  • Disease stage
  • Health disparities
  • National Cancer Database
  • Oropharyngeal cancer
  • Uninsured

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

The impact of health insurance status on stage at diagnosis of oropharyngeal cancer. / Chen, Amy Y.; Schrag, Nicole M.; Halpern, Michael; Ward, Elizabeth M.

In: Cancer, Vol. 110, No. 2, 15.07.2007, p. 395-402.

Research output: Contribution to journalArticle

Chen, Amy Y. ; Schrag, Nicole M. ; Halpern, Michael ; Ward, Elizabeth M. / The impact of health insurance status on stage at diagnosis of oropharyngeal cancer. In: Cancer. 2007 ; Vol. 110, No. 2. pp. 395-402.
@article{fe0e2880b8404a63a77d49b592040694,
title = "The impact of health insurance status on stage at diagnosis of oropharyngeal cancer",
abstract = "BACKGROUND. Although patients who have early-stage oropharyngeal cancer can be treated with little impairment of function, the treatment of advanced disease can result in decreased quality of life and mortality. Patients without insurance and with other barriers to access to care may delay seeking medical attention for early symptoms, resulting in more advanced disease at presentation. In this study, the authors examined whether patients who had no insurance or who were covered by Medicaid insurance were more likely to present with advanced oropharyngeal cancer. METHODS. In this retrospective cohort study from the National Cancer Database from 1996 to 2003, patients with known insurance status who were diagnosed with invasive oropharyngeal cancer at Commission on Cancer facilities (n = 40,487) were included. Adjusted and unadjusted logistic regression models were used to analyze the likelihood of presenting with more advanced stage disease. RESULTS. After controlling for other sociodemographic characteristics, patients with advanced oropharyngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.37; 95{\%} confidence interval [95{\%} CI], 1.21-1.25) or covered by Medicaid (OR, 1.31; 95{\%} CI, 1.19-1.46) compared with patients who had private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.82; 95{\%} CI, 2.46-3.23) or covered by Medicaid (OR, 2.95; 95{\%} CI, 2.63-3.31). They also were more likely to present with the greatest degree of lymph node involvement (N3) if they were uninsured (OR, 2.06; 95{\%} CI, 1.76-2.40) or covered by Medicaid (OR, 1.66; 95{\%} CI, 1.45-1.90). CONCLUSIONS. Individuals who lacked insurance or had Medicaid coverage were at the greatest risk for presenting with advanced oropharyngeal cancer. In the current study, the results for the Medicaid group may have been influenced by the postdiagnostic enrollment of uninsured patients. Insurance coverage appeared to be a highly modifiable predictor of cancer stage. The findings indicated that it is important to consider the impact of insurance coverage on disease stage at diagnosis and associated morbidity, mortality, and quality of life.",
keywords = "Access to care, Commission on Cancer, Disease stage, Health disparities, National Cancer Database, Oropharyngeal cancer, Uninsured",
author = "Chen, {Amy Y.} and Schrag, {Nicole M.} and Michael Halpern and Ward, {Elizabeth M.}",
year = "2007",
month = "7",
day = "15",
doi = "10.1002/cncr.22788",
language = "English (US)",
volume = "110",
pages = "395--402",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

TY - JOUR

T1 - The impact of health insurance status on stage at diagnosis of oropharyngeal cancer

AU - Chen, Amy Y.

AU - Schrag, Nicole M.

AU - Halpern, Michael

AU - Ward, Elizabeth M.

PY - 2007/7/15

Y1 - 2007/7/15

N2 - BACKGROUND. Although patients who have early-stage oropharyngeal cancer can be treated with little impairment of function, the treatment of advanced disease can result in decreased quality of life and mortality. Patients without insurance and with other barriers to access to care may delay seeking medical attention for early symptoms, resulting in more advanced disease at presentation. In this study, the authors examined whether patients who had no insurance or who were covered by Medicaid insurance were more likely to present with advanced oropharyngeal cancer. METHODS. In this retrospective cohort study from the National Cancer Database from 1996 to 2003, patients with known insurance status who were diagnosed with invasive oropharyngeal cancer at Commission on Cancer facilities (n = 40,487) were included. Adjusted and unadjusted logistic regression models were used to analyze the likelihood of presenting with more advanced stage disease. RESULTS. After controlling for other sociodemographic characteristics, patients with advanced oropharyngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.37; 95% confidence interval [95% CI], 1.21-1.25) or covered by Medicaid (OR, 1.31; 95% CI, 1.19-1.46) compared with patients who had private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.82; 95% CI, 2.46-3.23) or covered by Medicaid (OR, 2.95; 95% CI, 2.63-3.31). They also were more likely to present with the greatest degree of lymph node involvement (N3) if they were uninsured (OR, 2.06; 95% CI, 1.76-2.40) or covered by Medicaid (OR, 1.66; 95% CI, 1.45-1.90). CONCLUSIONS. Individuals who lacked insurance or had Medicaid coverage were at the greatest risk for presenting with advanced oropharyngeal cancer. In the current study, the results for the Medicaid group may have been influenced by the postdiagnostic enrollment of uninsured patients. Insurance coverage appeared to be a highly modifiable predictor of cancer stage. The findings indicated that it is important to consider the impact of insurance coverage on disease stage at diagnosis and associated morbidity, mortality, and quality of life.

AB - BACKGROUND. Although patients who have early-stage oropharyngeal cancer can be treated with little impairment of function, the treatment of advanced disease can result in decreased quality of life and mortality. Patients without insurance and with other barriers to access to care may delay seeking medical attention for early symptoms, resulting in more advanced disease at presentation. In this study, the authors examined whether patients who had no insurance or who were covered by Medicaid insurance were more likely to present with advanced oropharyngeal cancer. METHODS. In this retrospective cohort study from the National Cancer Database from 1996 to 2003, patients with known insurance status who were diagnosed with invasive oropharyngeal cancer at Commission on Cancer facilities (n = 40,487) were included. Adjusted and unadjusted logistic regression models were used to analyze the likelihood of presenting with more advanced stage disease. RESULTS. After controlling for other sociodemographic characteristics, patients with advanced oropharyngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.37; 95% confidence interval [95% CI], 1.21-1.25) or covered by Medicaid (OR, 1.31; 95% CI, 1.19-1.46) compared with patients who had private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.82; 95% CI, 2.46-3.23) or covered by Medicaid (OR, 2.95; 95% CI, 2.63-3.31). They also were more likely to present with the greatest degree of lymph node involvement (N3) if they were uninsured (OR, 2.06; 95% CI, 1.76-2.40) or covered by Medicaid (OR, 1.66; 95% CI, 1.45-1.90). CONCLUSIONS. Individuals who lacked insurance or had Medicaid coverage were at the greatest risk for presenting with advanced oropharyngeal cancer. In the current study, the results for the Medicaid group may have been influenced by the postdiagnostic enrollment of uninsured patients. Insurance coverage appeared to be a highly modifiable predictor of cancer stage. The findings indicated that it is important to consider the impact of insurance coverage on disease stage at diagnosis and associated morbidity, mortality, and quality of life.

KW - Access to care

KW - Commission on Cancer

KW - Disease stage

KW - Health disparities

KW - National Cancer Database

KW - Oropharyngeal cancer

KW - Uninsured

UR - http://www.scopus.com/inward/record.url?scp=34547154376&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34547154376&partnerID=8YFLogxK

U2 - 10.1002/cncr.22788

DO - 10.1002/cncr.22788

M3 - Article

C2 - 17562558

AN - SCOPUS:34547154376

VL - 110

SP - 395

EP - 402

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 2

ER -