Transcript Survival of Cancer Patients in the United States (1995

Cancer Survival According to
Insurance Status in Kentucky
Hannah K Weir, PhD
Epidemiology and Applied Research Branch
North American Association of Central Cancer Registries
Quebec City, Quebec, Canada
June 2010
National Center for Chronic Disease Prevention and Health Promotion
Division of Cancer Prevention and Control
Co-Authors
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Thomas C Tucker, Kentucky Cancer Registry, Lexington,
Kentucky, USA
Claudia Allemani, National Cancer Institute, Milan, Italy
Bernard Rachet, London School of Hygiene and Tropical
Medicine (LSHTM), London, UK
Michel P Coleman, LSHTM, London, UK
Institute of Medicine
Ensuring Quality Cancer Care
“ We all want to believe that
when people get cancer, they
will receive medical care of the
highest quality. Even as new
scientific breakthroughs are
announced, though, many
cancer patients may be getting
the wrong care, too little care,
or too much care, in the form
of unnecessary procedures.”
(IOM I999)
Avoidable Deaths
“…equal treatment yields equal outcome among
patients with the same stage of disease regardless of
race,…”
Brawley OW, Freeman HP. Race and outcomes: is this the end of the beginning for
minority health research? J Natl Cancer Inst 1999; 91: 1908-9
“…. geography or socio-economic status”.
Rachet B, Woods LM, Mitry E, Riga M, Cooper C, Quinn MJ, Steward JA, Brenner H,
Estève J, Sullivan R, Coleman MP. Cancer survival in England and Wales at the end
of the 20th century. Br J Cancer 2008; 99 (Suppl. 1): 2-10
What survival can tell us
Clinical trials - highest achievable survival
Population - overall survival achieved
Coleman MP. Opinion: why the variation in breast cancer survival
in Europe? Breast Cancer Res 1999, 1:22-24
Cancer Survival in Kentucky
and Health Insurance Coverage
(McDavid et al. 2003)
3-year relative survival for cancer patients diagnosed
with female breast, colorectal, prostate and lung
cancers between 1995-1998 varied by insurance
type
Objective of this study
To update and extend the previous study to include Kentucky
women diagnosed with cervical cancer, and to examine the
impact of insurance type, race and SES on cancer survival
estimated from individual patient data
Methods and Materials
• KY residents (15-99 years), diagnosed with invasive breast
(female), colorectal, lung, prostate cancer or cervical cancer
during 1995-2006 and followed through 2007
• Constructed age-, sex-, race-, calendar year- and SES-specific
life tables to adjust for background mortality.
– SES: quintiles based on 200% below poverty and extracted from the
county attributes file available from SEER and linked to the life-table
through the variable county.
• Estimated 1- and 3- year relative survival (RS) by insurance
type using the cohort approach.
Health Insurance Categories
Private:
Medicare:
managed care, HMO, PPO, private insurance
without supplement, including administered
managed Care
Medicare Plus: Medicare with supplement, private
supplement or with MEDICAID
Federal:
TRICARE, Military, Veterans affairs,
Indian/Public Health Service
Medicaid:
including administered managed Care
Insurance NOS: insured, not otherwise specified
Uninsured:
not insured and including self pay
Unknown:
insurance status unknown
Case Counts by Health Insurance
Breast (N=29,144)
Private
5811
20%
Medicare
3029
10 %
Medicare Plus 8645
30%
Federal
229
1%
Medicaid
1483
5%
Ins, NOS
7144
25%
Uninsured
1022
4%
Unknown
1781
6%
Colorectal (N=24,359)
Private
2961
12%
Medicare
4026
17%
Medicare Plus 10313
42%
Federally
524
2%
Medicaid
909
4%
Ins, NOS
3481
14%
Uninsured
664
3%
Unknown
1481
6%
One- and 3-year relative survival (%) by health insurance:
Breast cancer, women diagnosed 2003-2006, FU 2007
Private insurance
Medicare+supplement
Medicare
Other Federally funded
Medicaid
Insurance, NOS
Not insured
Unknown
0
20
40
60
80
100
Trends in Breast Cancer 3-year RS
by Health Insurance
100
90
80
70
60
50
40
30
20
10
0
1995-1998
1999-2002
2003-2006
One- and 3-year relative survival (%) by health insurance:
Colorectal, patients diagnosed 2003-2006, FU 2007
Private insurance
Medicare+supplement
Medicare
Other Federally funded
Medicaid
Insurance, NOS
Not insured
Unknown
0
20
40
60
80
100
Trends in Colorectal Cancer 3-year RS
By Health Insurance
100
90
80
70
60
50
40
30
20
10
0
1995-1998
1999-2002
2003-2006
Conclusion
• 3-year RS for breast and colorectal cancer
varied by health insurance
• Highest for private and insured NOS
• Lowest for Medicaid, uninsured and
insurance status unknown
• Survival for breast and colorectal cancer
improved between 1995 and 2006 for private
and insurance NOS
Limitations
• Those with unspecified insurance (NOS)
accounted for a large number of cases
• Health insurance may represent insurance
status at initial presentation or at discharge
(e.g., Medicare)
• Analyses not currently adjusted for age, stage
or treatment
Future Direction
• Analyses to include additional cancers
• The relationship between relative survival and
insurance type, SES, race, stage at diagnosis,
gender and treatment will be examined with
multi-variable excess hazard models
Thank You
Hannah K Weir
770 488-3006
[email protected]
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected]
Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of
the Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health Promotion
Division of Cancer Prevention and Control