Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/93456
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Type: Journal article
Title: The association between insurance status and prostate cancer outcomes: implications for the Affordable Care Act
Author: Mahal, B.
Aizer, A.
Ziehr, D.
Hyatt, A.
Lago-Hernandez, C.
Chen, Y.
Choueiri, T.
Hu, J.
Sweeney, C.
Beard, C.
D'Amico, A.
Martin, N.
Trinh, Q.
Nguyen, P.
Citation: Prostate Cancer and Prostatic Diseases, 2014; 17(3):273-279
Publisher: Nature Publishing Group
Issue Date: 2014
ISSN: 1365-7852
1476-5608
Statement of
Responsibility: 
B A Mahal, A A Aizer, D R Ziehr, A S Hyatt, C Lago-Hernandez, Y-W Chen, T K Choueiri, J C Hu, C J Sweeney, C J Beard, A V D'Amico, N E Martin, Q-D Trinh, and P L Nguyen
Abstract: BACKGROUND: The Affordable Care Act (ACA) aims to expand health insurance coverage to over 30 million previously uninsured Americans. To help evaluate the potential impact of the ACA on prostate cancer care, we examined the associations between insurance coverage and prostate cancer outcomes among men <65 years old who are not yet eligible for Medicare. METHODS: The Surveillance, Epidemiology and End Results Program was used to identify 85 203 men aged <65 years diagnosed with prostate cancer from 2007 to 2010. Multivariable logistic regression modeled the association between insurance status and stage at presentation. Among men with high-risk disease, the associations between insurance status and receipt of definitive therapy, prostate cancer-specific mortality (PCSM) and all-cause mortality were determined using multivariable logistic, Fine and Gray competing-risks and Cox regression models, respectively. RESULTS: Uninsured patients were more likely to be non-white and come from regions of rural residence, lower median household income and lower education level (P<0.001 for all cases). Insured men were less likely to present with metastatic disease (adjusted odds ratio (AOR) 0.23; 95% confidence interval (CI) 0.20-0.27; P<0.001). Among men with high-risk disease, insured men were more likely to receive definitive treatment (AOR 2.29; 95% CI 1.81-2.89; P<0.001), and had decreased PCSM (adjusted hazard ratio 0.56; 95% CI 0.31-0.98; P=0.04) and all-cause mortality (adjusted hazard ratio 0.60; 0.39-0.91; P=0.01). CONCLUSIONS: Insured men with prostate cancer are less likely to present with metastatic disease, more likely to be treated if they develop high-risk disease and are more likely to survive their cancer, suggesting that expanding health coverage under the ACA may significantly improve outcomes for men with prostate cancer who are not yet eligible for Medicare.
Keywords: Prostatic Neoplasms
Population Surveillance
SEER Program
Insurance, Health
Insurance Coverage
Patient Protection and Affordable Care Act
Rights: © 2014 Macmillan Publishers Limited
DOI: 10.1038/pcan.2014.23
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