Association of insurance status and age with cervical cancer stage at diagnosis: National Cancer Database, 2000-2007

Abstract

Objectives: We examined the relationship of age at diagnosis and insurance status with stage among cervical cancer patients aged 21 to 85 years.

Methods: We selected data on women (n = 69 739) diagnosed with invasive cervical cancer between 2000 and 2007 from the National Cancer Database. We evaluated the association between late stage (stage III/IV) and both insurance and age, with adjustment for race/ethnicity and other sociodemographic and clinical factors. We used multivariable log binomial models to estimate risk ratios (RRs) and 95% confidence intervals (CIs).

Results: The proportion of late-stage disease increased with age: from 16.53% (21-34 years) to 42.44% (≥ 70 years). The adjusted relative risk of advanced-stage disease among women aged 50 years and older was 2.2 to 2.5 times that of patients aged 21 to 34 years. Uninsured (RR = 1.44; 95% CI = 1.40, 1.49), Medicaid (RR = 1.37, 95% CI = 1.34, 1.41), younger Medicare (RR = 1.12, 95% CI = 1.06, 1.19), and older Medicare (RR = 1.20, 95% CI = 1.15, 1.26) patients had a higher risk of late-stage disease than did privately insured patients.

Conclusions: Screening should be encouraged for women at high risk for advanced-stage disease.

FIGURE 1—

Invasive cervical cancer diagnoses and screening, by age group and insurance category, for (a) late-stage diagnosis and (b) Papanicolaou test in past 3 years: United States. Source. (a) National Cancer Database, 2000–2007¹⁴; (b) National Health Interview Survey, 2000–2005.