ASPO Abstracts
Lung Cancer Survival in SEER patients under 65 by Insurance Status
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research, Cancer Health Disparities
Conference Year: 2018
Abstract Body:
Introduction/Purpose: Lung cancer is the leading cause of new cancers and cancer deaths in the United States. Past SEER reports have shown an increased incidence of lung cancer in individuals at younger ages. Disparities and access to care are a prime cause of concern among those not yet eligible for Medicare, which automatically covers individuals >65 years. The purpose of this report is to examine the relationship between lung cancer survival in individuals <65 years of age and factors related to access to care, such as insurance type, socioeconomic status, residence and demographic/clinical factors. Methods: Data were obtained from the SEER Database provided by the National Cancer Institute, which consists of 18 population-based, central cancer registries. Lung/bronchus cancer diagnoses from 2017-2013 were classified by SEER using the ICD10 codes, 34.0-34.9. The following factors were also collected from the SEER database: year of diagnosis, age, sex, race, ethnicity, insurance, marital status, stage at diagnosis, histology, rural-urban residence and median income. Cox proportional hazards regressions models were used to estimate hazard ratios (HR) and assess whether insurance and potential confounders were associated with lung cancer survival. Results: A total of 112,400 individuals <65 years with lung cancer were identified for this analysis. Over half were male (54%) and 78% were white with a mean age of 56 years. Regarding insurance status, 28% of individuals reported having Medicaid insurance, 68% reported having other unspecified insurance, and 8% were uninsured. Cox proportional hazard regression models revealed no significant difference between those with Medicaid versus the uninsured, but an increased probability of survival for those with other insurance compared to the uninsured, adjusting for covariates (HR=0.86, P<0.0001; P-trend<0.0001). White versus Black race also showed an increased probability of survival adjusting for other factors (HR=0.90, P<0.001). Conclusion: Prognosis for uninsured individuals diagnosed with lung and bronchus cancer <65 years of age was worse than for those with insurance, even after adjustment for important factors such as stage at diagnosis, race and factors summarizing area- based socioeconomic status.
Keywords: Lung cancer, survival, insurance