ASPO Abstracts
Impact of Insurance Status on Survival and Late-stage Disease Presentation among US Gastric Cancer Patients: A SEER Population Analysis
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose: The impact of insurance status on cause-specific survival and risk of late-stage disease among gastric cancer (GC) patients in the US have been less well defined. Methods: A retrospective study was performed using population-based data of GC patients aged 18-64 years in Surveillance Epidemiology and End Results (SEER), 2007-2016. GC was pathologically confirmed. Events were defined as GC-specific deaths; patients without the event were censored at the time of death from other causes or at the last known follow-up. Late-stage disease was stage III or IV. Insurance status was categorized as uninsured, Medicaid, and private insurance. Median survival time (in months) by insurance group was compared using Kaplan-Meier statistics with log-rank tests. Cox proportional hazards regression was used to assess the association between insurance status and GC-specific survival. Logistic regression was used to examine the relationship of insurance status and late-stage disease presentation. Results: Of 5,529 patients, 78.1% were aged ≥50 years, 54.2% were White, 19.4% were Hispanic, and 14.0% were Black. 73.4% had private insurance, followed by 19.5% Medicaid and 7.1% uninsured. Patients with private insurance had greater median survival time (22, 95% CI: 21-23) than those with Medicaid (14, 95% CI: 13-16) or uninsured (10, 95% CI: 8-12). The five-year GC-specific survival was higher for the private insurance group (33.9%) than for the Medicaid (24.8%) or uninsured (19.2%) group (p<0.0001). In the adjusted model, patients with Medicaid (adjusted hazard ratio [aHR] 1.2, 95% CI: 1.1-1.3) or uninsured (aHR 1.4, 95% CI: 1.3-1.6) had worse GC-specific survival than those with private insurance. In the adjusted model, the odds of late-stage disease presentation were higher in the uninsured (adjusted odds ratio [aOR] 1.6, 95% CI: 1.3-2.1) or Medicaid (aOR 1.3, 95% CI: 1.1-1.6) group than in the private insurance group. Compared with Black patients, Hispanic patients had a greater odds of late-stage disease presentation (aOR 1.4, 95% CI: 1.1-1.7). Conclusion: Our findings highlight the need for policy interventions addressing insurance coverage among GC patients and inform screening strategies for ethnic minority populations at risk of late-stage disease.
Keywords: Insurance, cause-specific survival, disparities, gastric cancer, SEER