California Trends in Cancer Survival by Health Insurance Status

Key Points

  • Compared with privately insured patients, those with no insurance had higher cancer-related mortality for breast cancer, lung cancer in men and women, and colorectal cancer in women.
  • Patients with other public insurance had higher cancer-related mortality for breast, prostate, and colorectal cancers in men and women.

A study using California Cancer Registry data showed that survival improvements in patients with cancer between 1997 and 2014 have largely been limited to those with private or Medicare insurance. These findings were reported in JAMA Oncology by Libby et al.

Study Details

The study involved California Cancer Registry data from January 1997 to December 2002, January 2003 to December 2008, and January 2009 to December 2014, with follow-up through 2014. A total of 1,149,891 patients diagnosed with breast, prostate, colorectal, or lung cancer or melanoma were included. Five-year cancer-specific and all-cause mortality were assessed according to insurance status, comparing private insurance with no insurance, Medicare alone or Medicare plus private insurance (Medicare), and any public, military, or any Medicaid and/or Medi-Cal insurance (other public insurance).

Mortality Trends

Overall, improvements in survival were almost exclusively limited to patients with private or Medicare insurance, with survival for those with other public or no insurance being largely unchanged or declining over the study period. Compared with patients with private insurance, cancer-specific mortality was higher in uninsured patients for all cancers except prostate cancer, with disparities being largest from 2009 to 2014 for breast cancer (hazard ratio [HR] = 1.72, 95% confidence interval [CI] = 1.45–2.03), lung cancer in men (HR = 1.18, 95% CI = 1.06–1.31) and women (HR = 1.32, 95% CI = 1.15–1.50), and colorectal cancer in women (HR = 1.30, 95% CI = 1.05–1.62). Similarly, cancer-specific mortality was higher among patients with other public insurance for all cancers except lung cancer, with disparities being largest from 2009 to 2014 for breast cancer (HR = 1.25, 95% CI = 1.17–1.34), prostate cancer (HR = 1.17, 95% CI = 1.04–1.31), and colorectal cancer in men (HR = 1.16, 95% CI = 1.08–1.23) and women (HR = 1.11, 95% CI = 1.03–1.20).

Disparities in all-cause mortality for uninsured and other publicly insured patients were generally similar to those for cancer-specific mortality. Survival among patients with Medicare was similar to that for privately insured patients, except for consistently higher mortality in breast and colorectal cancers.

The investigators concluded: “After accounting for patient and clinical characteristics, survival disparities for men with prostate cancer and women with lung or colorectal cancer increased significantly over time, reflecting a lack of improvement in survival for patients with other public insurance or no insurance. To mitigate these growing disparities, all patients with cancer need access to health insurance that covers all the necessary elements of health care, from prevention and early detection to timely treatment according to clinical guidelines.”

Libby Ellis, PhD, of the Cancer Prevention Institute of California, is the corresponding author of the JAMA Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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