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Effects of payer status on breast cancer survival: a retrospective study.

Shi R, Taylor H, McLarty J, Liu L, Mills G, Burton G - BMC Cancer (2015)

Bottom Line: Patients with private, unknown, or Medicare status showed a decreased risk of dying compared to uninsured, with a decrease of 36%, 22%, and 15% respectively.However, Medicaid patients had an increased risk of 11% compared to uninsured.Payer status showed a statistically significant relationship with overall survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine & Feist-Weiller Cancer Center, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA. rshi@lsuhsc.edu.

ABSTRACT

Background: Breast cancer outcomes are influenced by multiple factors including access to care, and payer status is a recognized barrier to treatment access. To further define the influence of payer status on outcome, the National Cancer Data Base data from 1998-2006 was analyzed.

Method: Data was analyzed from 976,178 female patients diagnosed with breast cancer registered in the National Cancer Data Base. Overall survival was the primary outcome variable while payer status was the primary predictor variable. Secondary predictor variables included stage, age, race, Charlson Comorbidity index, income, education, distance travelled, cancer program, diagnosing/treating facility, and treatment delay. Multivariate Cox regression was used to investigate the effect of payer status on overall survival while adjusting for secondary predictive factors.

Results: Uninsured (28.68%) and Medicaid (28.0%) patients had a higher percentage of patients presenting with stage III and stage IV cancer at diagnosis. In multivariate analysis, after adjusting for secondary predictor variables, payer status was a statistically significant predictor of survival. Patients with private, unknown, or Medicare status showed a decreased risk of dying compared to uninsured, with a decrease of 36%, 22%, and 15% respectively. However, Medicaid patients had an increased risk of 11% compared to uninsured. The direct adjusted median overall survival was 14.92, 14.76, 14.56, 13.64, and 12.84 years for payer status of private, unknown, Medicare, uninsured, and Medicaid respectively.

Conclusion: We observed that patients with no insurance or Medicaid were most likely to be diagnosed at stage III and IV. Payer status showed a statistically significant relationship with overall survival. This remained true after adjusting for other predictive factors. Patients with no insurance or Medicaid had higher mortality.

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Related in: MedlinePlus

Direct adjusted survivor functions for payer status. Direct adjusted median overall survival (MOS) was 14.9, 14.8, 14.6, 13.6, and 12.8 years for private, unknown, Medicare, uninsured, and Medicaid respectively.
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Fig1: Direct adjusted survivor functions for payer status. Direct adjusted median overall survival (MOS) was 14.9, 14.8, 14.6, 13.6, and 12.8 years for private, unknown, Medicare, uninsured, and Medicaid respectively.

Mentions: Figure 1 illustrates the Direct Adjusted MOS found for payer status only. The Direct Adjusted MOS was 14.92, 14.76, 14.56, 13.64, and 12.84 years for private, unknown, Medicare, uninsured, and Medicaid payer status respectively. Patients with private insurance had a 2.1 year longer survival compared to patients with Medicaid insurance.Figure 1


Effects of payer status on breast cancer survival: a retrospective study.

Shi R, Taylor H, McLarty J, Liu L, Mills G, Burton G - BMC Cancer (2015)

Direct adjusted survivor functions for payer status. Direct adjusted median overall survival (MOS) was 14.9, 14.8, 14.6, 13.6, and 12.8 years for private, unknown, Medicare, uninsured, and Medicaid respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4383189&req=5

Fig1: Direct adjusted survivor functions for payer status. Direct adjusted median overall survival (MOS) was 14.9, 14.8, 14.6, 13.6, and 12.8 years for private, unknown, Medicare, uninsured, and Medicaid respectively.
Mentions: Figure 1 illustrates the Direct Adjusted MOS found for payer status only. The Direct Adjusted MOS was 14.92, 14.76, 14.56, 13.64, and 12.84 years for private, unknown, Medicare, uninsured, and Medicaid payer status respectively. Patients with private insurance had a 2.1 year longer survival compared to patients with Medicaid insurance.Figure 1

Bottom Line: Patients with private, unknown, or Medicare status showed a decreased risk of dying compared to uninsured, with a decrease of 36%, 22%, and 15% respectively.However, Medicaid patients had an increased risk of 11% compared to uninsured.Payer status showed a statistically significant relationship with overall survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine & Feist-Weiller Cancer Center, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA. rshi@lsuhsc.edu.

ABSTRACT

Background: Breast cancer outcomes are influenced by multiple factors including access to care, and payer status is a recognized barrier to treatment access. To further define the influence of payer status on outcome, the National Cancer Data Base data from 1998-2006 was analyzed.

Method: Data was analyzed from 976,178 female patients diagnosed with breast cancer registered in the National Cancer Data Base. Overall survival was the primary outcome variable while payer status was the primary predictor variable. Secondary predictor variables included stage, age, race, Charlson Comorbidity index, income, education, distance travelled, cancer program, diagnosing/treating facility, and treatment delay. Multivariate Cox regression was used to investigate the effect of payer status on overall survival while adjusting for secondary predictive factors.

Results: Uninsured (28.68%) and Medicaid (28.0%) patients had a higher percentage of patients presenting with stage III and stage IV cancer at diagnosis. In multivariate analysis, after adjusting for secondary predictor variables, payer status was a statistically significant predictor of survival. Patients with private, unknown, or Medicare status showed a decreased risk of dying compared to uninsured, with a decrease of 36%, 22%, and 15% respectively. However, Medicaid patients had an increased risk of 11% compared to uninsured. The direct adjusted median overall survival was 14.92, 14.76, 14.56, 13.64, and 12.84 years for payer status of private, unknown, Medicare, uninsured, and Medicaid respectively.

Conclusion: We observed that patients with no insurance or Medicaid were most likely to be diagnosed at stage III and IV. Payer status showed a statistically significant relationship with overall survival. This remained true after adjusting for other predictive factors. Patients with no insurance or Medicaid had higher mortality.

Show MeSH
Related in: MedlinePlus