Abstract
Purpose The impact of insurance status on cause-specific survival and late-stage disease presentation among US patients with gastric cancer (GC) has been less well-defined.
Materials and Methods A retrospective study analyzed the 2007-2016 Surveillance Epidemiology and End Results. GC events were defined as GC-specific deaths; patients without the event were censored at the time of death from other causes or last known follow-up. Late-stage disease was stage III-IV. Insurance status was categorized as “uninsured/Medicaid/private.” Five-year survival rates were compared using log-rank tests. Cox regression was used to assess the association between insurance status and GC-specific survival. Logistic regression was used to examine the relationship of insurance status and late-stage disease presentation.
Results Of 5,529 patients, 78.1% were aged ≥50 years; 54.2% were White, 19.4% Hispanic, and 14.0% Black; 73.4% had private insurance, 19.5% Medicaid, and 7.1% uninsured. The 5-year survival was higher for the privately insured (33.9%) than those on Medicaid (24.8%) or uninsured (19.2%) (p<0.001). Patients with Medicaid (adjusted hazard ratio [aHR] 1.22, 95%CI: 1.11-1.33) or uninsured (aHR 1.43, 95%CI: 1.25-1.63) had worse survival than those privately insured. The odds of late-stage disease presentation were higher in the uninsured (adjusted odds ratio [aOR] 1.61, 95%CI: 1.25-2.08) or Medicaid (aOR 1.32, 95%CI: 1.12-1.55) group than those with private insurance. Hispanic patients had greater odds of late-stage disease presentation (aOR 1.35, 95%CI: 1.09-1.66) than Black patients.
Conclusions Findings highlight the need for policy interventions addressing insurance coverage among GC patients and inform screening strategies for populations at risk of late-stage disease.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
This work was supported in part by Susan G. Komen (TREND21675016) and the National Institute on Aging under grant award T32AG000243. Its contents are solely the responsibility of the author(s) and do not necessarily represent the official views of the National Institutes of Health/National Institute on Aging.
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The study used publicly available data from the Surveillance Epidemiology and End Results (SEER), 18 Registry.
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Data Availability
All data produced are available online at the Surveillance Epidemiology and End Results (SEER), 18 Registry.