1 Comprehensive Cancer Center, University of New Mexico firstname.lastname@example.org.
2 Department of Family and Community Medicine, University of New Mexico.
3 New Mexico Tumor Registry, University of New Mexico Comprehensive Cancer Center.
4 Department of Internal Medicine, University of New Mexico.
5 Cancer Research and Treatment Center, and Department of Internal Medicine, University of New Mexico.
6 Internal Medicine, Epidemiology, Biostatistics and Prevention, University of New Mexico.
BACKGROUND: For individuals with hepatocellular carcinoma (HCC), type of insurance may be an important prognostic factor because of its impact on access to care. This study investigates the relationship between insurance type at diagnosis and stage-specific survival.
METHODS: This retrospective cohort analysis used data from 18 Surveillance, Epidemiology, and End Results Program cancer registries. Individuals aged 20-64 years, diagnosed with primary HCC between 2010-2015, with either private, Medicaid, or no insurance were eligible for cohort inclusion. Adjusted Cox proportional-hazards regression models were used to generate hazard ratios (HR) and 95% confidence intervals (CI) for associations between insurance type at diagnosis and overall survival. All models were stratified by stage at diagnosis.
RESULTS: This analysis included 14,655 cases. Compared to privately insured individuals with the same stage of disease, those with Medicaid had a 43% (HR 1.43, 95% CI 1.13-1.32), 22% (HR 1.22, 95% CI 1.13-1.32), and 7% higher risk of death for localized, regional, and distant stage, respectively. Uninsured individuals had an 88% (HR 1.88, 95% CI 1.65-2.14), 59% (HR 1.59, 95% CI 1.41-1.80), and 35% (HR 1.35, 95% CI 1.18-1.55) higher risk of death for localized, regional, and distant stage, respectively, compared to privately insured individuals.
CONCLUSIONS: Disparities in survival exist by the type of insurance that individuals with HCC have at the time of diagnosis.
IMPACT: These findings support the need for additional research on access to and quality of cancer care for Medicaid and uninsured patients.