Insurance Payer Status and Race Explains Much of the Variability in Colorectal Cancer Survival

Abstract

Health care inequalities exist for patients with colon cancer. We hypothesize that factors such as payers and medical comorbidities may explain much of this inequality. Methods: Patients with colon cancer in the NCDB from 2003-2010 were identified in this study. Results: 541,649 patients were identified. Median age and survival were 68.6 years and 62.5 months. A majority of them (80.2%) were non-Hispanic white (NHW). African American (AA) and Hispanic (HS) patients were more likely to have medicaid (MD) or be uninsured (UI) and reside in counties with lower socio-economic status (SES). From univariate analysis, it was found that private insurance (PI) had superior survival (98.7 months) compared to MD (46.0 months), medicare (MC) (50.4 months) and UI (54.4 months). Survival was highest for HS (70.9 months) followed by NHW (63.2 months) and AA (53.0 months). Also, survival was linked to comorbidity index (CI), SES, chemotherapy, gender and surgical resection. On multivariate analysis, it was found that male (RR 1.11), SES, surgery (RR 2.29), chemotherapy (RR 1.96), CI, and stage were associated with survival. Race was a predictor of survival, with a survival advantage for HS (RR 0.87) and others (0.87) compared to NHW (1) and AA (1.2). Insurance status was strongly linked to survival. Compared to PI all other groups had poorer survival: MC RR 1.11; MD RR 1.44; and NI RR 1.42.Conclusions: Inequality in outcomes for colon cancer patients is strongly associated with race and underinsurance.