Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.?

Int J Environ Res Public Health. 2019 Sep 13;16(18):3393. doi: 10.3390/ijerph16183393.


Background: Scientific evidence on the effect of health insurance on racial disparities in urinary bladder cancer patients' survival is scant. The objective of our study was to determine whether insurance status modifies the association between race and bladder cancer specific survival during 2007-2015. Methods: The 2015 database of the cancer surveillance program of the National Cancer Institute (n = 39,587) was used. The independent variable was race (White, Black and Asian Pacific Islanders (API)), the main outcome was cancer specific survival. Health insurance was divided into uninsured, any Medicaid and insured. An adjusted model with an interaction term for race and insurance status was computed. Unadjusted and adjusted Cox regression analysis were applied. Results: Health insurance was a statistically significant effect modifier of the association between race and survival. Whereas, API had a lower hazard of death among the patients with Medicaid insurance (HR 0.67; 95% CI 0.48-0.94 compared with White patients, no differences in survival was found between Black and White urinary bladder carcinoma patients (HR 1.24; 95% CI 0.95-1.61). This may be due a lack of power. Among the insured study participants, Blacks were 1.46 times more likely than Whites to die of bladder cancer during the 5-year follow-up (95% CI 1.30-1.64). Conclusions: While race is accepted as a poor prognostic factor in the mortality from bladder cancer, insurance status can help to explain some of the survival differences across races.

Keywords: carcinoma; mortality; survival rate; transitional cell; urinary bladder neoplasms.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Continental Population Groups
  • Databases, Factual
  • Female
  • Humans
  • Insurance Coverage*
  • Insurance, Health*
  • Male
  • Medicaid
  • Middle Aged
  • Proportional Hazards Models
  • United States / epidemiology
  • United States / ethnology
  • Urinary Bladder Neoplasms / epidemiology*
  • Urinary Bladder Neoplasms / ethnology*