Lack of insurance cause of survivorship gap in minorities with cancer, study shows

January 09, 2020

Lack of insurance coverage is a major cause of delayed breast cancer screening and treatment among minority women, which could lead to a decrease in a patient's chance of survival. Nearly half of the disparity in later-stage diagnosis between non-Hispanic white women and black, Hispanic and Asian/Pacific Islander women was mediated by being uninsured or underinsured, according to a new study conducted at the University of Illinois at Chicago and Boston Medical Center/Boston University School of Medicine.

Non-Hispanic white women were insured at a higher rate at the time of diagnosis compared with non-Hispanic black women, American Indian/Alaska Native, Asian/Pacific Islander and Hispanic women, according to the study published in JAMA Oncology. The research was led by Gregory Calip, assistant professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy, and Dr. Naomi Ko, assistant professor at the Boston University School of Medicine.

"Diagnosing cancer at a later stage and lack of health insurance have negative consequences for patients and their families," said Calip, who is also a member of the University of Illinois Cancer Center. "Studies have examined the association of premature cancer-related mortality with lost productivity, and one estimated that in 2020 it will be just over $147 billion. The figure exceeded $308 billion when lost productivity of caregivers was considered."

"Inadequate health insurance coverage also mediates the growing survivorship gap experienced by racial and ethnic minorities with cancer."

Insurance is a modifiable risk factor, and "having adequate health insurance for all could reduce the persistent racial outcome disparities in breast cancer," Ko said.

"Patients diagnosed with breast cancer at a later stage typically require more intensive treatment and are at a higher risk for treatment-related morbidity and poorer overall quality of life, especially compared to those who receive chemotherapy," she said. "Diagnosing breast cancer early is not only beneficial for individual patients and families but also on society as a whole to decrease medical costs and promote equity among all populations."

More than 177,000 women age 40 to 64 who were diagnosed with invasive stage I to III breast cancer between 2010 and 2016 were included in the study, which used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results, or SEER, program. Funded by the National Cancer Institute, SEER includes population-based cancer incidence data for about 28% of the U.S. population, including demographic and clinic information.

This is the first study to use statistical mediation methods and a large cancer registry database to quantify the extent that adequate health insurance is a factor in the stage of breast cancer diagnosis among a diverse population of women in the United States.

Assisting Calip and Ko were Dr. Susan Hong, director of survivorship at the University of Illinois Cancer Center; and Dr. Robert Winn, director of the Virginia Commonwealth University Massey Cancer Center.
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The study was funded by the National Institutes of Health, National Center for Advancing Translational Sciences, National Cancer Institute and National Institute on Minority Health and Health Disparities (UL1TR002003, KL2TR000048, U54CA202997 and U54MD012523).

About the University of Illinois at Chicago

The University of Illinois at Chicago is an acclaimed research institution with 16 colleges dedicated to the discovery and distribution of knowledge. UIC is an incubator for life-saving research and an educator of more physicians, nurses, dentists and pharmacists for Illinois than any other school. Its seven health science colleges, which include the Jane Adams College of Social Work, the School of Public Health and its colleges of applied health sciences, dentistry, medicine, nursing and pharmacy actively integrate teaching, research and service while fostering compassion, dedication and advocacy. UI Health, UIC's clinical health enterprise, includes a 462-bed tertiary care hospital, 21 outpatient clinics, and a network of 12 Federally Qualified Health Centers (FQHCs).

About Boston Medical Center

Boston Medical Center is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $116 million in sponsored research funding in fiscal year 2017. It is the 15th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top-ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet - 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.bmc.org.

University of Illinois at Chicago

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