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Insurance status, comorbidity level, and survival among colorectal cancer patients age 18 to 64 years in the National Cancer Data Base from 2003 to 2005.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2009 Aug 01; Vol. 27 (22), pp. 3627-33. Date of Electronic Publication: 2009 May 26. - Publication Year :
- 2009
-
Abstract
- Purpose: Previous analyses have found that insurance status is a strong predictor of survival among patients with colorectal cancer aged 18 to 64 years. We investigated whether differences in comorbidity level may account in part for the association between insurance status and survival.<br />Methods: We used 2003 to 2005 data from the National Cancer Data Base, a national hospital-based cancer registry, to examine the relationship between baseline characteristics and overall survival at 1 year among 64,304 white and black patients with colorectal cancer. In race-specific analyses, we used Cox proportional hazards models to assess 1-year survival by insurance status, controlling first for age, stage, facility type, and neighborhood education level and income, and then further controlling for comorbidity level. RESULTS; Comorbidity level was lowest among those with private insurance, higher for those who were uninsured or insured by Medicaid, and highest for those insured by Medicare. Survival at 1 year was significantly poorer for patients without private insurance, even after adjusting for important covariates. In these multivariate models, risk of death at 1 year was approximately 50% to 90% higher for white and black patients without private insurance. Further adjustment for number of comorbidities had only a modest impact on the association between insurance status and survival. In multivariate analyses, patients with > or = three comorbid conditions had approximately 40% to 50% higher risk of death at 1 year. CONCLUSION Among white and black patients aged 18 to 64 years, differences in comorbidity level do not account for the association between insurance status and survival in patients with colorectal cancer.
- Subjects :
- Adolescent
Adult
Black or African American statistics & numerical data
Age Factors
Cause of Death
Colorectal Neoplasms pathology
Colorectal Neoplasms therapy
Confidence Intervals
Databases, Factual
Female
Health Services Accessibility statistics & numerical data
Humans
Kaplan-Meier Estimate
Male
Medicaid statistics & numerical data
Medically Uninsured statistics & numerical data
Medicare statistics & numerical data
Middle Aged
Multivariate Analysis
Outcome Assessment, Health Care
Probability
Proportional Hazards Models
Registries
Retrospective Studies
Socioeconomic Factors
Survival Analysis
United States
White People statistics & numerical data
Young Adult
Colorectal Neoplasms mortality
Comorbidity
Healthcare Disparities statistics & numerical data
Insurance Coverage economics
Subjects
Details
- Language :
- English
- ISSN :
- 1527-7755
- Volume :
- 27
- Issue :
- 22
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 19470927
- Full Text :
- https://doi.org/10.1200/JCO.2008.20.8025