Insurance Disparities Among Medicaid Patients with NSCLC Leads to Worse Survival


According to findings from the ASCO Annual Meeting, insurance disparities still exist, and may even contribute to cancer-specific and comorbidity-associated mortalities in patients with early-stage non-small cell lung cancer.

Despite the Affordable Care Act (ACA) and Medicaid expansion in 2010, insurance disparities among cause-specific mortalities in individuals with non-small cell lung cancer (NSCLC) still exist, according to study results presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting.

“Non-elderly, early stage NSCLC patients have the most promising prognosis with appropriate treatments,” the researchers wrote. “Studies have shown uninsured and elderly patients on Medicaid being less likely to receive guideline-concordant therapy and have higher mortality compared with other insured patients.”

However, it is still unknown how insurance status may influence cause-specific survival in this patient population, and whether the ACA has since improved disparities.

In the prospective cohort study, the researchers used data from the Surveillance, Epidemiology, and End Results (SEER) Program from 2007 to 2014 to identify 13,898 non-elderly patients with early-stage NSCLC. The average age among the cohort was 59 years, and the majority of patients were female (50.5 percent) and white (74.9 percent). Only 40.4 percent of patients in the cohort had a college education or above.

After adjusting for socio-demographic factors, tumor grade and treatment, patients who were o Medicaid and were non-insured were associated with higher lung cancer mortality. Of note, patients with any Medicaid had the highest mortality for cardiovascular diseases and non-cancer respiratory diseases across different insurance status.

“The most important thing here is to find the Medicaid population actually having the worst outcome of lung cancer survivors,” study author Changchuan Jiang M.D., MPH, from Mount Sinai St. Luke‘s-West Hospital and the Icahn School of Medicine at Mount Sinai in New York City, said in an interview with CURE.

“More importantly here, is that we found that they are more likely to die from cardiovascular disease and pulmonary disease, and their outcome is actually worse than other insurance compared with people without any insurance, which was kind of shocking to us.”

The researchers found that diagnosis after ACA was associated with lower lung cancer-specific mortality, and was also not related to cardiovascular disease- or non-cancer respiratory disease-mortality.

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Image of Dr. Minesh Mehta at ASCO 2024.