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    Does increasing insurance improve outcomes for US cancer patients

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    Authors
    Smith, Jillian K.
    Ng, Sing Chau
    Zhou, Zheng
    Carroll, James E. Jr.
    McDade, Theodore P.
    Shah, Shimul A.
    Tseng, Jennifer F.
    UMass Chan Affiliations
    Surgical Outcomes Analysis and Research, Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2013-11-01
    Keywords
    Adult
    Female
    Humans
    Incidence
    Insurance, Health
    Male
    Medically Uninsured
    Neoplasm Staging
    Neoplasms
    *Outcome Assessment (Health Care)
    Proportional Hazards Models
    SEER Program
    United States
    Health and Medical Administration
    Health Services Administration
    Health Services Research
    Insurance
    Neoplasms
    Surgery
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    http://dx.doi.org/10.1016/j.jss.2013.05.058
    Abstract
    BACKGROUND: Although debate continues on US healthcare and insurance reform, data are lacking on the effect of insurance on community-level cancer outcomes. Therefore, the objective of the present study was to examine the association of insurance and cancer outcomes. MATERIALS AND METHODS: The US Census Bureau Current Population Survey, Small Area Health Insurance Estimates (2000) were used for the rates of uninsurance. Counties were divided into tertiles according to the uninsurance rates. The data were compared with the cancer incidence and survival for patients residing in counties captured by the Surveillance, Epidemiology, and End Results database (2000-2006). Aggregate patient data were collected of US adults (aged >/=18 y) diagnosed with the following cancers: pancreatic, esophageal, liver or bile duct, lung or bronchial, ovarian, colorectal, breast, prostate, melanoma, and thyroid. The outcomes included the stage at diagnosis, surgery, and survival. Univariate tests and proportional hazards were calculated. RESULTS: The US uninsurance rate was 14.2%, and the range for the Surveillance, Epidemiology, and End Results counties was 8.3%-24.1%. Overall, patients from lower uninsurance rate counties demonstrated longer median survival. Adjusting for patient characteristics and cancer stage (for each cancer), the patients in the higher uninsurance rate counties demonstrated greater mortality (8%-15% increased risk on proportional hazards). The county uninsurance rate was associated with the stage at diagnosis for all cancers, except pancreatic and esophageal, and was also associated with the likelihood of being recommended for cancer-directed surgery (for all cancers). CONCLUSIONS: Health insurance coverage at a community level appears to influence survival for patients with cancer. Additional investigations are needed to examine whether individual versus community associations exist and how best to surmount barriers to cancer care.
    Source

    Smith JK, Ng SC, Zhou Z, Carroll JE, McDade TP, Shah SA, Tseng JF. Does increasing insurance improve outcomes for US cancer patients? J Surg Res. 2013 Nov;185(1):15-20. doi:10.1016/j.jss.2013.05.058. Link to article on publisher's site

    DOI
    10.1016/j.jss.2013.05.058
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/30136
    PubMed ID
    23773721
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    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jss.2013.05.058
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