Cargando…

Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.?

Background: Scientific evidence on the effect of health insurance on racial disparities in urinary bladder cancer patients’ survival is scant. The objective of our study was to determine whether insurance status modifies the association between race and bladder cancer specific survival during 2007–2...

Descripción completa

Detalles Bibliográficos
Autores principales: Morales, Juliana, Malles, Aaron, Kimble, Marrell, Rodriguez de la Vega, Pura, Castro, Grettel, Nieder, Alan M., Barengo, Noël C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765928/
https://www.ncbi.nlm.nih.gov/pubmed/31540198
http://dx.doi.org/10.3390/ijerph16183393
_version_ 1783454598603735040
author Morales, Juliana
Malles, Aaron
Kimble, Marrell
Rodriguez de la Vega, Pura
Castro, Grettel
Nieder, Alan M.
Barengo, Noël C.
author_facet Morales, Juliana
Malles, Aaron
Kimble, Marrell
Rodriguez de la Vega, Pura
Castro, Grettel
Nieder, Alan M.
Barengo, Noël C.
author_sort Morales, Juliana
collection PubMed
description Background: Scientific evidence on the effect of health insurance on racial disparities in urinary bladder cancer patients’ survival is scant. The objective of our study was to determine whether insurance status modifies the association between race and bladder cancer specific survival during 2007–2015. Methods: The 2015 database of the cancer surveillance program of the National Cancer Institute (n = 39,587) was used. The independent variable was race (White, Black and Asian Pacific Islanders (API)), the main outcome was cancer specific survival. Health insurance was divided into uninsured, any Medicaid and insured. An adjusted model with an interaction term for race and insurance status was computed. Unadjusted and adjusted Cox regression analysis were applied. Results: Health insurance was a statistically significant effect modifier of the association between race and survival. Whereas, API had a lower hazard of death among the patients with Medicaid insurance (HR 0.67; 95% CI 0.48–0.94 compared with White patients, no differences in survival was found between Black and White urinary bladder carcinoma patients (HR 1.24; 95% CI 0.95–1.61). This may be due a lack of power. Among the insured study participants, Blacks were 1.46 times more likely than Whites to die of bladder cancer during the 5-year follow-up (95% CI 1.30–1.64). Conclusions: While race is accepted as a poor prognostic factor in the mortality from bladder cancer, insurance status can help to explain some of the survival differences across races.
format Online
Article
Text
id pubmed-6765928
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-67659282019-09-30 Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.? Morales, Juliana Malles, Aaron Kimble, Marrell Rodriguez de la Vega, Pura Castro, Grettel Nieder, Alan M. Barengo, Noël C. Int J Environ Res Public Health Article Background: Scientific evidence on the effect of health insurance on racial disparities in urinary bladder cancer patients’ survival is scant. The objective of our study was to determine whether insurance status modifies the association between race and bladder cancer specific survival during 2007–2015. Methods: The 2015 database of the cancer surveillance program of the National Cancer Institute (n = 39,587) was used. The independent variable was race (White, Black and Asian Pacific Islanders (API)), the main outcome was cancer specific survival. Health insurance was divided into uninsured, any Medicaid and insured. An adjusted model with an interaction term for race and insurance status was computed. Unadjusted and adjusted Cox regression analysis were applied. Results: Health insurance was a statistically significant effect modifier of the association between race and survival. Whereas, API had a lower hazard of death among the patients with Medicaid insurance (HR 0.67; 95% CI 0.48–0.94 compared with White patients, no differences in survival was found between Black and White urinary bladder carcinoma patients (HR 1.24; 95% CI 0.95–1.61). This may be due a lack of power. Among the insured study participants, Blacks were 1.46 times more likely than Whites to die of bladder cancer during the 5-year follow-up (95% CI 1.30–1.64). Conclusions: While race is accepted as a poor prognostic factor in the mortality from bladder cancer, insurance status can help to explain some of the survival differences across races. MDPI 2019-09-13 2019-09 /pmc/articles/PMC6765928/ /pubmed/31540198 http://dx.doi.org/10.3390/ijerph16183393 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Morales, Juliana
Malles, Aaron
Kimble, Marrell
Rodriguez de la Vega, Pura
Castro, Grettel
Nieder, Alan M.
Barengo, Noël C.
Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.?
title Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.?
title_full Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.?
title_fullStr Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.?
title_full_unstemmed Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.?
title_short Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.?
title_sort does health insurance modify the association between race and cancer-specific survival in patients with urinary bladder malignancy in the u.s.?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765928/
https://www.ncbi.nlm.nih.gov/pubmed/31540198
http://dx.doi.org/10.3390/ijerph16183393
work_keys_str_mv AT moralesjuliana doeshealthinsurancemodifytheassociationbetweenraceandcancerspecificsurvivalinpatientswithurinarybladdermalignancyintheus
AT mallesaaron doeshealthinsurancemodifytheassociationbetweenraceandcancerspecificsurvivalinpatientswithurinarybladdermalignancyintheus
AT kimblemarrell doeshealthinsurancemodifytheassociationbetweenraceandcancerspecificsurvivalinpatientswithurinarybladdermalignancyintheus
AT rodriguezdelavegapura doeshealthinsurancemodifytheassociationbetweenraceandcancerspecificsurvivalinpatientswithurinarybladdermalignancyintheus
AT castrogrettel doeshealthinsurancemodifytheassociationbetweenraceandcancerspecificsurvivalinpatientswithurinarybladdermalignancyintheus
AT niederalanm doeshealthinsurancemodifytheassociationbetweenraceandcancerspecificsurvivalinpatientswithurinarybladdermalignancyintheus
AT barengonoelc doeshealthinsurancemodifytheassociationbetweenraceandcancerspecificsurvivalinpatientswithurinarybladdermalignancyintheus