The Association of Insurance and Stage at Diagnosis Among Patients Aged 55 to 74 Years in the National Cancer Database

摘要: Prior studies have demonstrated that individuals without health insurance are less likely to a usual source of care and receive preventive services including cancer screening more be diagnosed at late stages cancer. To examine the potential impact reform on stage diagnosis, we analyzed relationship between diagnosis status for patients who were nearly elderly (55-64 years old) younger (65-74 old). We examined with 8 common cancers from January 1, 2005, December 31, 2007, using data National Cancer Database, hospital-based registry jointly sponsored by American Society College Surgeons, which includes approximately 70% all malignant in United States treated 1400 facilities throughout States. site-specific multivariable log binomial models used generate risk ratio (RR) 95% confidence interval (CI) estimates advanced disease (stage III or IV vs I) category, controlling age, race/ethnicity, area level education. The final analytic cohort contained 843,177 patients. For each site, uninsured Medicaid-insured had highest proportion Joint Committee those private Medicare plus supplemental lowest. Risk ratios (95% CI) compared privately insured 1.75 (1.64-1.86) prostate, 1.12 (1.11-1.14) lung/bronchus, 2.08 (1.98-2.17) breast, 1.25 (1.22-1.27) colorectal, 1.51 (1.40-1.64) uterine corpus, 1.91 (1.73-2.12) urinary bladder, 1.80 (1.62-2.01) melanoma, 1.37 (1.24-1.51) thyroid cancers. Lower RRs observed coverage alone 1.23 (1.17-1.29) 1.05 (1.03-1.06) 1.41 (1.33-1.48) 1.08 (1.05-1.10) 1.20 (1.11-1.31) 1.54 (1.40-1.70) 1.13 (1.01-1.26) 1.10 (1.01-1.21) thyroid. In contrast, there was no significant difference late-stage any site Advantage programs. If extends large adults currently provides benefits equal better than coverage, is decrease, particularly subpopulations low rates coverage.