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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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2019
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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 |
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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 |
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