Impact of Health Insurance on Stage at Cancer Diagnosis Among Adolescents and Young Adults

Theresa H.M. Keegan, Helen M. Parsons, Yi Chen, Frances B. Maguire, Cyllene R. Morris, Arti Parikh-Patel, Kenneth W. Kizer, Ted Wun

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Uninsured adolescents and young adults (AYAs) and those with publicly funded health insurance are more likely to be diagnosed with cancer at later stages. However, prior population-based studies have not distinguished between AYAs who were continuously uninsured from those who gained Medicaid coverage at the time of cancer diagnosis. METHODS: AYA patients (ages 15-39 years) with nine common cancers diagnosed from 2005 to 2014 were identified using California Cancer Registry data. This cohort was linked to California Medicaid enrollment files to determine continuous enrollment, discontinuous enrollment, or enrollment at diagnosis, with other types of insurance determined from registry data. Multivariable logistic regression was used to evaluate factors associated with later stages at diagnosis. RESULTS: The majority of 52 774 AYA cancer patients had private or military insurance (67.6%), followed by continuous Medicaid (12.4%), Medicaid at diagnosis (8.5%), discontinuous Medicaid (3.9%), other public insurance (1.6%), no insurance (2.9%), or unknown insurance (3.1%). Of the 13 069 with Medicaid insurance, 50.1% were continuously enrolled. Compared to those who were privately insured, AYAs who enrolled in Medicaid at diagnosis were 2.2-2.5 times more likely to be diagnosed with later stage disease, whereas AYAs discontinuously enrolled were 1.7-1.9 times and AYAs continuously enrolled were 1.4-1.5 times more likely to be diagnosed with later stage disease. Males, those residing in lower socioeconomic neighborhoods, and AYAs of Hispanic or black race and ethnicity (vs non-Hispanic white) were more likely to be diagnosed at a later stage, independent of insurance. CONCLUSIONS: Our findings suggest that access to continuous medical insurance is important for decreasing the likelihood of late stage cancer diagnosis.

Original languageEnglish (US)
Pages (from-to)1152-1160
Number of pages9
JournalJournal of the National Cancer Institute
Volume111
Issue number11
DOIs
StatePublished - Nov 1 2019

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Health Insurance
Insurance
Medicaid
Young Adult
Neoplasms
Registries
Hispanic Americans
Logistic Models
Population

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Keegan, T. H. M., Parsons, H. M., Chen, Y., Maguire, F. B., Morris, C. R., Parikh-Patel, A., ... Wun, T. (2019). Impact of Health Insurance on Stage at Cancer Diagnosis Among Adolescents and Young Adults. Journal of the National Cancer Institute, 111(11), 1152-1160. https://doi.org/10.1093/jnci/djz039

Impact of Health Insurance on Stage at Cancer Diagnosis Among Adolescents and Young Adults. / Keegan, Theresa H.M.; Parsons, Helen M.; Chen, Yi; Maguire, Frances B.; Morris, Cyllene R.; Parikh-Patel, Arti; Kizer, Kenneth W.; Wun, Ted.

In: Journal of the National Cancer Institute, Vol. 111, No. 11, 01.11.2019, p. 1152-1160.

Research output: Contribution to journalArticle

Keegan, THM, Parsons, HM, Chen, Y, Maguire, FB, Morris, CR, Parikh-Patel, A, Kizer, KW & Wun, T 2019, 'Impact of Health Insurance on Stage at Cancer Diagnosis Among Adolescents and Young Adults', Journal of the National Cancer Institute, vol. 111, no. 11, pp. 1152-1160. https://doi.org/10.1093/jnci/djz039
Keegan, Theresa H.M. ; Parsons, Helen M. ; Chen, Yi ; Maguire, Frances B. ; Morris, Cyllene R. ; Parikh-Patel, Arti ; Kizer, Kenneth W. ; Wun, Ted. / Impact of Health Insurance on Stage at Cancer Diagnosis Among Adolescents and Young Adults. In: Journal of the National Cancer Institute. 2019 ; Vol. 111, No. 11. pp. 1152-1160.
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abstract = "BACKGROUND: Uninsured adolescents and young adults (AYAs) and those with publicly funded health insurance are more likely to be diagnosed with cancer at later stages. However, prior population-based studies have not distinguished between AYAs who were continuously uninsured from those who gained Medicaid coverage at the time of cancer diagnosis. METHODS: AYA patients (ages 15-39 years) with nine common cancers diagnosed from 2005 to 2014 were identified using California Cancer Registry data. This cohort was linked to California Medicaid enrollment files to determine continuous enrollment, discontinuous enrollment, or enrollment at diagnosis, with other types of insurance determined from registry data. Multivariable logistic regression was used to evaluate factors associated with later stages at diagnosis. RESULTS: The majority of 52 774 AYA cancer patients had private or military insurance (67.6{\%}), followed by continuous Medicaid (12.4{\%}), Medicaid at diagnosis (8.5{\%}), discontinuous Medicaid (3.9{\%}), other public insurance (1.6{\%}), no insurance (2.9{\%}), or unknown insurance (3.1{\%}). Of the 13 069 with Medicaid insurance, 50.1{\%} were continuously enrolled. Compared to those who were privately insured, AYAs who enrolled in Medicaid at diagnosis were 2.2-2.5 times more likely to be diagnosed with later stage disease, whereas AYAs discontinuously enrolled were 1.7-1.9 times and AYAs continuously enrolled were 1.4-1.5 times more likely to be diagnosed with later stage disease. Males, those residing in lower socioeconomic neighborhoods, and AYAs of Hispanic or black race and ethnicity (vs non-Hispanic white) were more likely to be diagnosed at a later stage, independent of insurance. CONCLUSIONS: Our findings suggest that access to continuous medical insurance is important for decreasing the likelihood of late stage cancer diagnosis.",
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AU - Parsons, Helen M.

AU - Chen, Yi

AU - Maguire, Frances B.

AU - Morris, Cyllene R.

AU - Parikh-Patel, Arti

AU - Kizer, Kenneth W.

AU - Wun, Ted

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N2 - BACKGROUND: Uninsured adolescents and young adults (AYAs) and those with publicly funded health insurance are more likely to be diagnosed with cancer at later stages. However, prior population-based studies have not distinguished between AYAs who were continuously uninsured from those who gained Medicaid coverage at the time of cancer diagnosis. METHODS: AYA patients (ages 15-39 years) with nine common cancers diagnosed from 2005 to 2014 were identified using California Cancer Registry data. This cohort was linked to California Medicaid enrollment files to determine continuous enrollment, discontinuous enrollment, or enrollment at diagnosis, with other types of insurance determined from registry data. Multivariable logistic regression was used to evaluate factors associated with later stages at diagnosis. RESULTS: The majority of 52 774 AYA cancer patients had private or military insurance (67.6%), followed by continuous Medicaid (12.4%), Medicaid at diagnosis (8.5%), discontinuous Medicaid (3.9%), other public insurance (1.6%), no insurance (2.9%), or unknown insurance (3.1%). Of the 13 069 with Medicaid insurance, 50.1% were continuously enrolled. Compared to those who were privately insured, AYAs who enrolled in Medicaid at diagnosis were 2.2-2.5 times more likely to be diagnosed with later stage disease, whereas AYAs discontinuously enrolled were 1.7-1.9 times and AYAs continuously enrolled were 1.4-1.5 times more likely to be diagnosed with later stage disease. Males, those residing in lower socioeconomic neighborhoods, and AYAs of Hispanic or black race and ethnicity (vs non-Hispanic white) were more likely to be diagnosed at a later stage, independent of insurance. CONCLUSIONS: Our findings suggest that access to continuous medical insurance is important for decreasing the likelihood of late stage cancer diagnosis.

AB - BACKGROUND: Uninsured adolescents and young adults (AYAs) and those with publicly funded health insurance are more likely to be diagnosed with cancer at later stages. However, prior population-based studies have not distinguished between AYAs who were continuously uninsured from those who gained Medicaid coverage at the time of cancer diagnosis. METHODS: AYA patients (ages 15-39 years) with nine common cancers diagnosed from 2005 to 2014 were identified using California Cancer Registry data. This cohort was linked to California Medicaid enrollment files to determine continuous enrollment, discontinuous enrollment, or enrollment at diagnosis, with other types of insurance determined from registry data. Multivariable logistic regression was used to evaluate factors associated with later stages at diagnosis. RESULTS: The majority of 52 774 AYA cancer patients had private or military insurance (67.6%), followed by continuous Medicaid (12.4%), Medicaid at diagnosis (8.5%), discontinuous Medicaid (3.9%), other public insurance (1.6%), no insurance (2.9%), or unknown insurance (3.1%). Of the 13 069 with Medicaid insurance, 50.1% were continuously enrolled. Compared to those who were privately insured, AYAs who enrolled in Medicaid at diagnosis were 2.2-2.5 times more likely to be diagnosed with later stage disease, whereas AYAs discontinuously enrolled were 1.7-1.9 times and AYAs continuously enrolled were 1.4-1.5 times more likely to be diagnosed with later stage disease. Males, those residing in lower socioeconomic neighborhoods, and AYAs of Hispanic or black race and ethnicity (vs non-Hispanic white) were more likely to be diagnosed at a later stage, independent of insurance. CONCLUSIONS: Our findings suggest that access to continuous medical insurance is important for decreasing the likelihood of late stage cancer diagnosis.

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