Abstract PO-209: Breast cancer survival disparities by insurance status or racial/ethnic in specific patient populations

Abstract

Abstract Introduction: Health insurance status reflects patients’ socioeconomic status, which determines healthcare access and is associated with prognosis and survival. Limited research has reported the association between insurance status and breast cancer survival, potentially mediated through healthcare access. Method: Tumor registry data from University of Miami Health System and Jackson Memorial Hospital between 2008 to 2018 were used to estimate the association between race/ethnicity, insurance status and tumor stage at diagnosis; effect of insurance status on the likelihood of receiving specific breast cancer treatment; and overall survival by race/ethnicity and insurance status. Overall, 4392 breast cancer patients were included in the study. Odds ratios (ORs) and 95% confidence intervals (CIs) for the likelihood of being diagnosed with advanced stage breast cancer by race/ethnicity and insurance status, and likelihood of receiving specific treatments by insurance status and race/ethnicity were evaluated. Five-year overall survival probabilities and hazard ratios (HRs) by race/ethnicity and insurance status were also examined. Results: African-American patients and patients who had Medicaid or were uninsured were more likely to be diagnosed with advanced stage breast cancer. Under-coverage patients were less likely to receive cancer-specific treatment. Five- year survival rate was significantly lower in African-Americans compared to non- Hispanic whites (74.2% and 85.7%; p<.001). Overall survival was also significantly worse in African-Americans compared to non-Hispanic Whites (HR, 1.40; 95%CI, 1.12-1.76). Patients who had Medicare (<65 years of age) (HR, 1.84; 95%CI, 1.19- 2.86) or Medicaid (HR, 1.23; 95%CI, 1.00-1.51) had significantly worse survival compared to patients with private insurance. Among HER2 positive patients, those who were covered by Medicare (≥65 years) (HR, 3.02; 95%CI, 1.04-8.80), Medicaid (HR, 2.31; 95%CI, 1.14-4.69), or no insurance (HR, 3.02; 95%CI, 1.44-6.32) had significantly higher hazards of death than privately insured patients. Conclusions: This study identified Medicare, Medicaid, and uninsured patients as having higher hazards of death compared to privately insured patients, which can inform health professionals and policy makers to advocate for equal health outcomes regardless of insurance. Citation Format: Kaicheng Wang, Jennifer J. Hu, Isildinha M. Reis, Wei Zhao, George R. Yang, Stuart Herna. Breast cancer survival disparities by insurance status or racial/ethnic in specific patient populations [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-209.