Cancer survival in Kentucky and health insurance coverage
ABSTRACT 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.
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ABSTRACT: To determine the extent to which socioeconomic and racial/ethnic differences in cancer screening discussion between a patient and his/her primary care physician are due to "within-physician" differences (the fact that patients were treated differently by the same physicians) versus "between-physician" differences (that they were treated by a different group of physicians). We use data from the baseline patient and physician surveys of two community trials from the Communication in Medical Care (CMC) research series. The two studies combined provide an analysis sample of 5,978 patients ages 50-80 nested within 191 primary care physicians who practiced throughout Southern California. Our main outcomes of interest are whether the physician has ever talked to the patient about fecal occult blood test (FOBT; for colorectal cancer screening), mammogram (for breast cancer screening, female patients only) and the prostate-specific antigen test (PSA, male patients only). We consider five racial/ethnic groups: non-Hispanic white, non-Hispanic black, Hispanic, Asian, and other race/ethnicity. We measure socioeconomic status by both income and education. For each type of cancer screening discussion, we first estimate a probit model that includes patient characteristics as the only covariates to assess the overall differences. We then add physician fixed effects to derive estimates of "within-" versus "between-" physician differences. There was a strong education gradient in the discussion of all three types of cancer screening and most of the education differences arose within physicians. Disparities by income were less consistent across different screening methods, but seemed to have arisen mainly because of "between-physician" differences. Asians were much less likely, compared with whites, to have received discussion about FOBT and PSA and these differences were mainly "within-physician" differences. Black female patients, however, were much more likely, compared with whites treated by the same physicians, to have discussed mammogram with their physicians. Differences in cancer screening discussion along the different dimensions of patient SES may have arisen because of very different mechanisms and therefore call for a combination of interventions. Physicians need to be aware of the persistent disparities by patient education in clinical communication regarding cancer screening and tailor their efforts to the needs of low-education patients. Quality-improvement efforts targeted at physicians practicing in low-income communities may also be effective in addressing disparities in cancer screening communication by patient income.Health Services Research 07/2007; 42(3 Pt 1):950-70. DOI:10.1111/j.1475-6773.2006.00638.x · 2.49 Impact Factor
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ABSTRACT: Racial disparities in health care and health outcomes are a disturbing feature of the American health care system. Efforts to reduce or ameliorate these disparities must be informed by an understanding of the factors that underlie and contribute to them. The papers in this issue are based on a recent conference that was held at the University of Chicago to address this problem. Socioeconomic status is an important determinant of health, and socioeconomic disparities are major determinants of the racial disparities in health. These socioeconomic disparities are complicated by access to health insurance, geographic factors, and unhealthy behaviors. Geographic disparities, both regional and local, also contribute to racial disparities in health. Moreover, current disparities in the health of adult populations may reflect socioeconomic disparities that prevailed during their intrauterine or early infant development. There seems little evidence that either overt or unconscious discrimination on the part of physicians is an important cause of racial disparities in health; blaming physicians for this problem is counterproductive. Improving the quality of medical care holds the promise not only of improving health for all Americans, but of decreasing the racial disparities in health care that are so troubling today.Perspectives in biology and medicine 02/2005; 48(1 Suppl):S1-9. DOI:10.1353/pbm.2005.0046 · 0.54 Impact Factor
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ABSTRACT: Breast cancer treatment in underserved populations continues to deviate from established guidelines. Significant barriers persist at the system, physician, and patient levels that ultimately may affect survival adversely. Successful strategies to reduce the disparities must be developed to improve outcomes in this population of women.Surgical Oncology Clinics of North America 02/2005; 14(1):119-30, vii. DOI:10.1016/j.soc.2004.08.001 · 1.67 Impact Factor