Cancer Survival in Kentucky and Health Insurance Coverage
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. Archives of Internal Medicine
(Impact Factor: 17.33).
11/2003; 163(18):2135-44. DOI: 10.1001/archinte.163.18.2135
Access to health insurance influences the amount and quality of health care received, which in turn is likely to be related to survival. Few studies have systematically examined cancer survival by individual level health insurance data from a state population-based cancer registry for 4 anatomic sites.
Men and women aged 18 to 99 years who were registered from 1995 to 1998 with the Kentucky Cancer Registry, Lexington, with colorectal, lung, breast, or prostate cancer were followed up through 1999. Three-year crude and relative survival proportion by 7 health insurance categories and by sex for all 4 sites were calculated. Poisson regression was used to model the risk of death (controlling for age group at diagnosis, sex, race, stage at diagnosis, and treatment) relative to expected deaths in the general population from all 4 cancers by health insurance category.
Among patients with prostate cancer, 3-year relative survival proportion was 98% for the privately insured and 83% for the uninsured; comparable figures were 91% and 78% for patients with breast cancer; 71% and 53% for patients with colorectal cancer; and 23% and 13% for patients with lung cancer. For all 4 cancers the uninsured ranked fifth or sixth on survival, above patients with unknown insurance type or Medicaid/welfare.
These findings confirm purported disparities in cancer care and point toward the need to make quality care accessible to all segments of the population.
Available from: Mark Mcevoy
- "The current study indicated that persons with private health coverage were significantly more likely to seek early medical advice for rectal bleeding. Such a finding is not surprising, given that persons without health insurance are known to have limited access to medical care
 and poorer health outcomes
[70,71] compared to privately insured persons. For this group it is proposed that increased morbidity and mortality of CRC is a result of restricted access to medical and surgical care
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Little data exists on the factors associated with health care seeking behaviour for primary symptoms of colorectal cancer (CRC). This study aimed to identify individual, provider and psychosocial factors associated with (i) ever seeking medical advice and (ii) seeking early medical advice for primary symptoms of colorectal cancer (CRC).
1592 persons aged 56–88 years randomly selected from the Hunter Community Study (HCS) were sent a questionnaire.
Males and those who had received screening advice from a doctor were at significantly higher odds of ever seeking medical advice for rectal bleeding. Persons who had private health coverage, consulted a doctor because the ‘symptom was serious’, or who did not wait to consult a doctor for another reason were at significantly higher odds of seeking early medical advice (< 2 weeks). For change in bowel habit, persons with lower income, within the healthy weight range, or who had discussed their family history of CRC irrespective of whether informed of ‘increased risk’ were at significantly higher odds of ever seeking medical advice. Persons frequenting their GP less often and seeing their doctor because the symptom persisted were at significantly higher odds of seeking early medical advice (< 2 weeks).
The seriousness of symptoms, importance of early detection, and prompt consultation must be articulated in health messages to at-risk persons. This study identified modifiable factors, both individual and provider-related to consultation behaviour. Effective health promotion efforts must heed these factors and target sub-groups less likely to seek early medical advice.
BMC Gastroenterology 08/2012; 12(1):100. DOI:10.1186/1471-230X-12-100 · 2.37 Impact Factor
Available from: ncbi.nlm.nih.gov
- "Various well-known factors have been linked with cancer including radiation, smoking, diet, obesity, physical inactivity (NCI, 2009a); inadequate health insurance coverage (McDavid et al. 2003); educational attainment (Albano et al. 2007); and income (Boyd et al. 1999). Although not necessarily reported as a predictor of cancer mortality, health perception has been linked with total mortality (Wannamethee and Shaper, 1991). "
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ABSTRACT: This ecological inquiry compares cancer mortality rates in the U.S. to the predictor of natural background radiation (via land elevation means) along with eight other predictors thought to be associated with cancer mortality. Age-adjusted cancer mortality in 2006 was compared to the predictors of mean land elevation, percent of smokers, educational attainment, percent of population without health insurance, income, obesity, health perception, physical activity, and diet. Among the six predictors considered appropriate for multiple linear regression, three were found to be statistically significant; from strongest to weakest, these three were: smoking, land elevation, and educational attainment. The predictors of smoking and educational attainment have long been considered associated with cancer mortality. The finding that the predictor of land elevation / natural background radiation is inversely related to cancer mortality is another piece of evidence supporting the theory of radiation hormesis. In this study, land elevation / natural background radiation ranked second in predictive strength regarding cancer mortality, behind smoking and ahead of educational attainment. Since this is an ecological inquiry, no causal inferences can be made.
Dose-Response 01/2012; 10(1):58-65. DOI:10.2203/dose-response.10-010.Hart · 1.22 Impact Factor
Available from: Yongmei Lu
- "In addition to stage at diagnosis, access to treatment services is also believed to influence cancer outcomes, as high-quality and timely treatment can extend a patient's life and lower the chance of dying from cancer (McDavid et al., 2003; Siminoff and Ross, 2005; Le et al., 2008; Dai, 2010; Tian et al., 2010; Kuo et al., 2011). Access to medical services can be influenced by spatial and non-spatial factors, with spatial access largely determined by geographic characteristics (i.e., location and distance) of the demanding population and related medical services and non-spatial access determined by individual and/or community socio-cultural factors (e.g., affluence, education, language fluency) (Aday and Andersen, 1974). "
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ABSTRACT: This paperreportsastudyexaminingtheassociationbetweencolorectalcancer(CRC)survivaland
Health & Place 01/2012; 18(2):321-329. · 2.81 Impact Factor
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