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

 -  2020 
<br/><br/> 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. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>2045-7634 
<br/><br/><label>Standard No.: </label>10.1002/cam4.3109 [doi] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>IN PROCESS -- NOT YET INDEXED
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Health Research Institute<br/>MedStar Heart & Vascular Institute<br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Radiology
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article