Effect of Health Insurance and Ethnicity on the Treatment Outcome of Colon Cancer

BACKGROUND: Colon cancer is the second most prevalent type of cancer in the Westernized world. The present standard of care is surgery and appropriate use of adjuvant therapy. This is often a costly endeavor and requires not only access to high quality care but the ability to pay for such care, often requiring the need for health insurance. This study seeks to determine the effect of insurance payer and ethnicity on colon cancer treatment and survival.

METHODS: The study resembled a cross-sectional type and used incidence cases of colon cancer in Florida from January 1, 2004 to December 31, 2009.

RESULTS: The crude colon cancer mortality rate was 28.4%, 95% CI= (28.0, 28.8). The controlled mortality rate by race was 30.5%, 95% CI= (29.3, 31.7) for African American, 28.6%, 95% CI= (28.2, 29.1) for Caucasian and 25.7%, 95% CI= (24.7, 26.8) for Hispanic, all significantly different.  African-Americans did not demonstrate a significant risk of death than Caucasians when controlling for all the other covariates, but Hispanics were 16% less likely to die than Caucasians when adjusting for all other covariates.  The controlled mortality rate by insurance type was significantly lower for HMO 20.7%, 95% CI= (20.0, 21.4), than for Medicaid 30.2%, 95% CI= (28.2, 32.2), Medicare 30.1%, 95% CI= (29.6, 30.6) and uninsured 49.7%, 95% CI= (48.0, 51.4). Using Cox proportional regression modeling, patients with insurance type HMO, HR=0.63, 95 % CI=(0.59, 0.68), Medicaid, HR=0.82, 95% CI=(0.74, 0.90) and Medicare, HR=0.69, 95% CI=(0.65, 0.74 ) had 37%, 18% and 31% less risk, respectively, of dying than persons uninsured when adjusting for treatment, race/ethnicity, gender, histology, marital status and stage at diagnosis.

CONCLUSIONS: There is evidence of insurance payor and ethnic disparities in colon cancer treatment and outcome. These findings may support the argument in favor of universal health insurance coverage.