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Does Insurance Type Predict Stage at Diagnosis?

Amy Y. Chen, MD, MPH; Nicole M. Schrag, MSPH; Michael Halpern, MD, PhD; Andrew Stewart, MS; Elizabeth M. Ward, PhD

Arch Otolaryngol Head Neck Surg. 2007;133(8):784-790.

Objective  To examine whether patients with no insurance or Medicaid are more likely to present with advanced-stage laryngeal cancer.

Design  Retrospective cohort study from the National Cancer Database, 1996-2003.

Setting  Hospital-based practice.

Participants  Patients with known insurance status diagnosed as having invasive laryngeal cancer at Commission on Cancer facilities (N = 61 131) were included. Adjusted and unadjusted logistic regression models analyzed the likelihood of presenting at a more advanced stage.

Main Outcome Measures  Overall stage of laryngeal cancer (early vs advanced) and tumor size (T stage) at diagnosis.

Results  Patients with advanced-stage laryngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.79-2.15) or covered by Medicaid (OR, 2.40; 95% CI, 2.21-2.61) compared with those with private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.92; 95% CI, 2.60-3.28) or covered by Medicaid (OR, 3.97; 95% CI, 3.56-4.34). Patients who were black, between ages 18 and 56 years, and who resided in zip codes with low proportions of high school graduates or low median household incomes were also more likely to be diagnosed as having advanced disease and/or larger tumors.

Conclusions  Individuals lacking insurance or having Medicaid are at greatest risk for presenting with advanced laryngeal cancer. Results for the Medicaid group may be influenced by the postdiagnosis enrollment of uninsured patients. It is important to consider the impact of insurance coverage on stage at diagnosis and associated morbidity, mortality, quality of life, and costs.

Author Affiliations: Department of Otolaryngology, Emory University (Dr Chen), and Department of Health Services Research, American Cancer Society (Drs Chen, Halpern, and Ward and Ms Schrag), Atlanta, Georgia; and American College of Surgeons, Chicago, Illinois (Mr Stewart).

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