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Ethnicity and insurance status predict metastatic disease presentation in prostate, breast, and non-small cell lung cancer.

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Citation: Cancer Medicine. 2020 Jun 08PMID: 32511873Institution: MedStar Health Research Institute | MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: RadiologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020 ISSN:

2045-7634

Name of journal: Cancer medicineAbstract: BACKGROUND: Ethnicity and insurance status have been shown to impact odds of presenting with metastatic cancer, however, the interaction of these two predictors is not well understood. We evaluate the difference in odds of presenting with metastatic disease in minorities compared to white patients despite access to the same insurance across three common cancer types.CONCLUSIONS: Insurance status provided the single most protective effect against metastatic presentation. This benefit varied for minorities despite similar insurance. Reducing metastatic disease presentation rates requires addressing social barriers to care independent of insurance. Copyright (c) 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.METHODS: Using the National Cancer Database, a multilevel logistic regression model that estimated the odds of metastatic disease was fit, adjusting for covariates including year of diagnosis, ethnicity, insurance, income, and region. We included adults diagnosed with metastatic prostate, non-small cell lung cancer (NSCLC), and breast cancer from 2004 to 2015.RESULTS: The study cohort consisted of 1 191 241 prostate cancer (PCa), 1 310 986 breast cancer (BCa), and 1 183 029 NSCLC patients. Private insurance was the most protective factor against metastatic presentation. Odds of presenting with metastatic disease were 0.190 [95% CI, 0.182-0.198], 0.616 [95% CI, 0.602-0.630], and 0.270 [95% CI, 0.260-0.279] for PCa, NSCLC, and BCa compared to uninsured patients, respectively. Private insurance provided the most significant benefit to non-Hispanic White PCa patients with 81% reduction in odds of metastatic presentation and conferred the least benefit to African- American NSCLC patients at 30.4% reduction in odds of metastatic presentation.All authors: Aghdam N, Al-Refaie WB, Dash C, Fernandez S, McGunigal M, Mete M, Repka MC, Unger KR, Wang HFiscal year: FY2020Digital Object Identifier:

https://dx.doi.org/10.1002/cam4.3109

ORCID:

https://orcid.org/0000-0002-2590-5522 https://orcid.org/0000-0002-6264-144X https://orcid.org/0000-0002-2590-5522 https://orcid.org/0000-0002-6264-144X
https://orcid.org/0000-0002-2590-5522 https://orcid.org/0000-0002-6264-144X https://orcid.org/0000-0002-2590-5522 https://orcid.org/0000-0002-6264-144X

Date added to catalog: 2020-08-26

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Title notes ( 5 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	32511873	Available		32511873

BACKGROUND: Ethnicity and insurance status have been shown to impact odds of presenting with metastatic cancer, however, the interaction of these two predictors is not well understood. We evaluate the difference in odds of presenting with metastatic disease in minorities compared to white patients despite access to the same insurance across three common cancer types.

CONCLUSIONS: Insurance status provided the single most protective effect against metastatic presentation. This benefit varied for minorities despite similar insurance. Reducing metastatic disease presentation rates requires addressing social barriers to care independent of insurance. Copyright (c) 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

METHODS: Using the National Cancer Database, a multilevel logistic regression model that estimated the odds of metastatic disease was fit, adjusting for covariates including year of diagnosis, ethnicity, insurance, income, and region. We included adults diagnosed with metastatic prostate, non-small cell lung cancer (NSCLC), and breast cancer from 2004 to 2015.

RESULTS: The study cohort consisted of 1 191 241 prostate cancer (PCa), 1 310 986 breast cancer (BCa), and 1 183 029 NSCLC patients. Private insurance was the most protective factor against metastatic presentation. Odds of presenting with metastatic disease were 0.190 [95% CI, 0.182-0.198], 0.616 [95% CI, 0.602-0.630], and 0.270 [95% CI, 0.260-0.279] for PCa, NSCLC, and BCa compared to uninsured patients, respectively. Private insurance provided the most significant benefit to non-Hispanic White PCa patients with 81% reduction in odds of metastatic presentation and conferred the least benefit to African- American NSCLC patients at 30.4% reduction in odds of metastatic presentation.

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