Association of health insurance with outcomes in adults ages 18 to 64 years with melanoma in the United States

• Published in: Journal of the American Academy of Dermatology Vol. 74; no. 2; pp. 309 - 316
• Main Authors: Amini, Arya, MD, Rusthoven, Chad G., MD, Waxweiler, Timothy V., MD, Jones, Bernard L., PhD, Fisher, Christine M., MD, MPH, Karam, Sana D., MD, PhD, Raben, David, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2016
• Subjects: Adult; Affordable Care Act; Cross-Sectional Studies; Dermatology; Female; health care disparities; health insurance; Humans; Insurance, Health - statistics & numerical data; Kaplan-Meier Estimate; Male; malignant melanoma; Medicaid - statistics & numerical data; Medically Uninsured - statistics & numerical data; Melanoma - mortality; Melanoma - pathology; Melanoma - therapy; Middle Aged; Neoplasm Staging; Retrospective Studies; SEER Program; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Skin Ulcer - epidemiology; Skin Ulcer - etiology; Survival Rate; treatment outcomes; United States - epidemiology; Young Adult; United States; SES; cause-specific survival; CSS; OR; OS; health insurance; CI; health care disparities; HR; odds ratio; Affordable Care Act; malignant melanoma; treatment outcomes; hazard ratio; overall survival; SEER; confidence interval; Surveillance, Epidemiology, and End Results; socioeconomic status
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2015.09.054

Background Studies evaluating insurance status and melanoma outcomes are limited. Objective We investigated whether health insurance correlates with more advanced disease, receipt of treatment, and survival in melanoma. Methods This was a cross-sectional analysis of 61,650 patients with cutaneous melanoma using the Surveillance, Epidemiology, and End Results database. Results Under multivariate analysis, patients with either Medicaid insurance (hazard ratio, 1.83; 95% confidence interval [CI], 1.65-2.04; P  < .001) or uninsured status (hazard ratio, 1.63; 95% CI, 1.44-1.85; P  < .001) were more likely to die of any cause, including melanoma. Uninsured compared with non-Medicaid insured cases more often presented with increasing tumor thickness (odds ratio [OR], 2.19; 95% CI, 1.76-2.73; P  < .001) and presence of ulceration (OR, 1.64; 95% CI, 1.40-1.92; P  < .001), and less often received treatment (OR, 1.87; 95% CI, 1.60-2.19; P  < .001). Compared with non-Medicaid insured, Medicaid cases more often had increasing tumor thickness (OR, 2.36; 95% CI, 1.91-2.91; P  < .001), advanced stage (OR, 1.59; 95% CI, 1.37-1.85; P  < .001), and presence of ulceration (OR, 1.40; 95% CI, 1.19-1.63; P  < .001), and less often received treatment (OR, 1.61; 95% CI, 1.37-1.89; P  < .001). Limitations This was a retrospective study. Conclusion Patients with melanoma and Medicaid or uninsured status were more likely to present with advanced disease and were less likely to receive treatment, likely contributing to an overall and cause-specific survival detriment. Addressing access to care may help improve these outcomes.