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Forgoing needed medical care among long-term survivors of childhood cancer: racial/ethnic-insurance disparities

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Abstract

Purpose

To investigate racial/ethnic-related disparities by insurance status in “forgoing needed medical care in the last year due to finances” in childhood cancer survivors.

Methods

Our study included 3310 non-Hispanic/Latinx White, 562 non-Hispanic/Latinx Black, and 92 Hispanic/Latinx survivors from the St. Jude Lifetime Cohort Study. Logistic regression analyses, guided by Andersen’s Healthcare Utilization Model, were adjusted for “predisposing” (survey age, sex, childhood cancer diagnosis and treatment, and treatment era) and “need” (perceived health status) factors. Additional adjustment for household income/education and chronic health conditions was considered.

Results

Risk of forgoing care was highest among non-Hispanic/Latinx Blacks and lowest among Hispanics/Latinxs for each insurance status. Among privately insured survivors, relative to non-Hispanic/Latinx Whites, non-Hispanic/Latinx Blacks were more likely to forgo care (adjusted OR: 1.82, 95% CI: 1.30–2.54): this disparity remained despite additional adjustment for household income/education (adjusted OR: 1.43, 95% CI: 1.01–2.01). In contrast, publicly insured survivors, regardless of race/ethnicity, had similar risk of forgoing care as privately insured non-Hispanic/Latinx Whites. All uninsured survivors had high risk of forgoing care. Additional chronic health condition adjustment did not alter these results.

Conclusions

Provision of public insurance to all childhood cancer survivors may diminish racial/ethnic disparities in forgoing care that exist among the privately insured and reduce the risk of forgoing care among uninsured survivors to that of privately insured non-Hispanic/Latinx Whites.

Implications for Cancer Survivors

Under public insurance, childhood cancer survivors had low risk of forgoing care, at the similar level to privately insured non-Hispanic/Latinx Whites, regardless of race/ethnicity.

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Acknowledgements

The authors thank all individuals who participated in this study.

Availability of data and material

Most data are accessible through the St. Jude Cloud (https://stjude.cloud). A few variables that were used in this paper but are not available on St. Jude Cloud are available upon reasonable request to the corresponding author.

Code availability

Not applicable.

Funding

This work was supported by the US National Cancer Institute (P30-CA21765 and U01-CA195547) and the American Lebanese Syrian Associated Charities.

Author information

Author notes

  1. Jessica L. Baedke and Lauren A. Lindsey contributed equally to this work.

Authors and Affiliations

  1. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Jessica L. Baedke, I-Chan Huang, Kirsten K. Ness, Tara M. Brinkman, Nickhill Bhakta, Matthew J. Ehrhardt, William Letsou, Leslie L. Robison, Melissa M. Hudson & Yutaka Yasui

  2. School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada

    Lauren A. Lindsey, Cindy Im, Qi Liu & Yutaka Yasui

  3. Department of Surgery, Washington University School of Medicine, Campus Box 8109, 4590 Children’s Place, Suite 9600, St. Louis, MO, 63110, USA

    Aimee S. James

  4. Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers, MT-621, 1720 2nd Avenue South, Birmingham, AL, 35294, USA

    Carrie R. Howell

  5. Department of Psychology, St. Jude Children’s Research Hospital, Mailstop 740, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Tara M. Brinkman

  6. Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Mailstop 721, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Nickhill Bhakta

  7. Department of Oncology, St. Jude Children’s Research Hospital, Mailstop 260, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Nickhill Bhakta, Matthew J. Ehrhardt & Melissa M. Hudson

Authors
  1. Jessica L. Baedke
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Contributions

Concept and design: I-Chan Huang, Jessica L. Baedke, Lauren A. Lindsey, Leslie L. Robison, Melissa M. Hudson, Nickhill Bhakta, Tara M. Brinkman, Yutaka Yasui; funding acquisition: Leslie L. Robison, Melissa M. Hudson; administrative support: Kirsten K. Ness, Leslie L. Robison, Melissa M. Hudson, Tara M. Brinkman; provision of study materials: Kirsten K. Ness, Leslie L. Robison, Matthew J. Ehrhardt, Melissa M. Hudson; extraction and assembly of data: Carrie R. Howell, Jessica L. Baedke, Kirsten K. Ness, Lauren A. Lindsey; data analysis and interpretation: Aimee S. James, Cindy Im, I-Chan Huang, Jessica L. Baedke, Lauren A. Lindsey, Qi Liu, William Letsou, Yutaka Yasui; manuscript writing: Jessica L. Baedke, Lauren A. Lindsey, Yutaka Yasui; editing and final approval of manuscript: all authors.

Corresponding author

Correspondence to Yutaka Yasui.

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Ethics approval

The study was reviewed by the St. Jude Children’s Research Hospital Institutional Review Board and ethical approval was obtained on April 25, 2007. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

All participants provided written informed consent for participation in the St. Jude Lifetime Cohort Study.

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Not applicable.

Conflict of interest

The authors declare no competing interests.

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Baedke, J.L., Lindsey, L.A., James, A.S. et al. Forgoing needed medical care among long-term survivors of childhood cancer: racial/ethnic-insurance disparities. J Cancer Surviv 16, 677–687 (2022). https://doi.org/10.1007/s11764-021-01061-3

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