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Lack of Health Insurance Leads to Lack of Timely Cancer Diagnosis

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"Lack of Health Insurance Leads to Lack of Timely Cancer Diagnosis"

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There’s something very strange about the fact that the political exigencies of the health care debate seem to have led conservatives to want to deny that lack of health insurance leads to health problems for people. But that’s where the debate is. Thus “Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis” by Michael T Halpern MD, Elizabeth M Ward PhD, Alexandre L Pavluck MPH, Nicole M Schrag MSPH, John Bian PhD, and Amy Y Chen MD. Their conclusion is that people who don’t have health insurance are less likely to get cancer diagnosed in a timely manner, meaning that when cancer is diagnosed it tends to be relatively late-stage:

Findings
3 742 407 patients were included in the analysis; patient characteristics were similar to those of the corresponding US population not included in the analysis. Uninsured and Medicaid-insured patients were significantly more likely to present with advanced-stage cancer compared with privately insured patients. This finding was most prominent for patients who had cancers that can potentially be detected early by screening or symptom assessment (eg, breast, colorectal, and lung cancer, as well as melanoma). For example, the odds ratios for advanced-stage disease (stage III or IV) at diagnosis for uninsured or Medicaid-insured patients with colorectal cancer were 2·0 (95% CI 1·9—2·1) and 1·6 (95% CI 1·5—1·7), respectively, compared with privately-insured patients. For advanced-stage melanoma, the odds ratios were 2·3 (2·1—2·5) for uninsured patients and 3·3 (3·0—3·6) for Medicaid-insured patients compared with privately insured patients. Black and Hispanic patients were noted to have an increased risk of advanced-stage disease (stage III or IV) at diagnosis, irrespective of insurance status, compared with White patients.

Interpretation
In this US-based analysis, uninsured and Medicaid-insured patients, and those from ethnic minorities, had substantially increased risks of presenting with advanced-stage cancers at diagnosis. Although many factors other than insurance status also affect the quality of care received, adequate insurance is a crucial factor for receiving appropriate cancer screening and timely access to medical care.

Somewhat unfortunately, this study lumps the Medicaid-insured in with the uninsured, even though my guess would be that if they were separated out the uninsured would do worse. It also doesn’t specifically verify that late cancer diagnosis leads to death. But at a minimum it leads to more arduous treatment regimes and most of what we know about cancer suggests that it does, in fact, lead to death.

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