Effects of health insurance and race on colorectal cancer treatments and outcomes

Am J Public Health. 2000 Nov;90(11):1746-54. doi: 10.2105/ajph.90.11.1746.

Abstract

Objectives: We hypothesized that health insurance payer and race might influence the care and outcomes of patients with colorectal cancer.

Methods: We examined treatments received for all incident cases of colorectal cancer occurring in Florida in 1994 (n = 9551), using state tumor registry data. We also estimated the adjusted risk of death (through 1997), using proportional hazards regression analysis controlling for other predictors of mortality.

Results: Treatments received by patients varied considerably according to their insurance payer. Among non-Medicare patients, those in the following groups had higher adjusted risks of death relative to commercial fee-for-service insurance: commercial HMO (risk ratio [RR] = 1.40; 95% confidence interval [CI] = 1.18, 1.67; P = .0001), Medicaid (RR = 1.44; 95% CI = 1.06, 1.97; P = .02), and uninsured (RR = 1.41; 95% CI = 1.12, 1.77; P = .003). Non-Hispanic African Americans had higher mortality rates (RR = 1.18; 95% CI = 1.01, 1.37; P = .04) than non-Hispanic Whites.

Conclusions: Patients with colorectal cancer who were uninsured or insured by Medicaid or commercial HMOs had higher mortality rates than patients with commercial fee-for-service insurance. Mortality was also higher among non-Hispanic African American patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • Colorectal Neoplasms / economics
  • Colorectal Neoplasms / mortality*
  • Colorectal Neoplasms / therapy*
  • European Continental Ancestry Group / statistics & numerical data*
  • Fee-for-Service Plans / statistics & numerical data
  • Female
  • Florida
  • Health Maintenance Organizations / statistics & numerical data
  • Health Services Research
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Incidence
  • Insurance, Health / statistics & numerical data*
  • Male
  • Medicaid / statistics & numerical data
  • Medically Uninsured / statistics & numerical data
  • Proportional Hazards Models
  • Registries
  • Socioeconomic Factors
  • Survival Analysis
  • Treatment Outcome
  • United States / epidemiology