Purpose: The impact of insurance status on cause-specific survival and late-stage disease presentation among US patients with gastric cancer (GC) has been less well-defined.
Materials and methods: A retrospective study analyzed the 2007-2016 Surveillance Epidemiology and End Results. GC events were defined as GC-specific deaths; patients without the event were censored at the time of death from other causes or last known follow-up. Late-stage disease was stage III-IV. Insurance status was categorized as "uninsured/Medicaid/private." Five-year survival rates were compared using log-rank tests. Cox regression was used to assess the association between insurance status and GC-specific survival. Logistic regression was used to examine the relationship of insurance status and late-stage disease presentation.
Results: Of 5,529 patients, 78.1% were aged ≥50 years; 54.2% were White, 19.4% Hispanic, and 14.0% Black; 73.4% had private insurance, 19.5% Medicaid, and 7.1% uninsured. The 5-year survival was higher for the privately insured (33.9%) than those on Medicaid (24.8%) or uninsured (19.2%) (p<0.001). Patients with Medicaid (adjusted hazard ratio [aHR] 1.22, 95%CI: 1.11-1.33) or uninsured (aHR 1.43, 95%CI: 1.25-1.63) had worse survival than those privately insured. The odds of late-stage disease presentation were higher in the uninsured (adjusted odds ratio [aOR] 1.61, 95%CI: 1.25-2.08) or Medicaid (aOR 1.32, 95%CI: 1.12-1.55) group than those with private insurance. Hispanic patients had greater odds of late-stage disease presentation (aOR 1.35, 95%CI: 1.09-1.66) than Black patients.
Conclusions: Findings highlight the need for policy interventions addressing insurance coverage among GC patients and inform screening strategies for populations at risk of late-stage disease.
Keywords: Insurance status; cause-specific survival; disease presentation; gastric cancer; racial/ethnic disparities.