The impact of insurance status on the survival outcomes of patients with renal cell carcinoma

BACKGROUND: The impact of insurance status on renal cell carcinoma (RCC) patient survival is unclear. In this study, we investigated the effects of insurance status on the survival outcomes of RCC patients in the United States of America. METHODS: Data of patients diagnosed with RCC between 2007 and 2014 were obtained from the Surveillance, Epidemiology and End Results (SEER) database, a large national database including statistics on cancer patients. The Kaplan-Meier method and Cox regression analysis were used to determine the influence of insurance status on cancer-specific survival (CSS). RESULTS: A total of 30,951 eligible RCC patients were identified. Of these patients, 25,493 (82.37%) were insured, 3,959 (12.79%) had any Medicaid coverage, and 1,499 (4.84%) were uninsured. Kaplan-Meier analysis revealed that insurance status was associated with better CCS (P<0.001). The 5-year CSS rates of patients with insurance, any Medicaid, and no insurance were 88.3%, 82.6%, and 82.7%, respectively. Multivariate Cox regression analysis showed that patients with any Medicaid had poorer CSS than insured patients [hazard ratio (HR), 1.222; 95% confidence interval (CI), 1.100–1.357]. Stratified analysis revealed that at localized tumor stage and at regional tumor stage or among white patients, any Medicaid insurance was an independent predictor of an unfavorable survival outcome. CONCLUSIONS: Among the RCC patients in this study, individuals with insurance experienced improved CSS while individuals with any Medicaid tended to suffer worse survival outcomes.