Association of Insurance Status and Cervical Cancer Tumor Size in the United States [22H

Abstract

INTRODUCTION: Health disparity based on insurance status has been of great attention recently. We sought to study the association of insurance status with cervical cancer tumor size at the time of diagnosis. METHODS: The US Surveillance, Epidemiology and End Results (SEER) database was accessed (1973-2016). Since the variable “Tumor Size Summary” was available only for the year of 2016, data for cervical cancer in 2016 in the United States were extracted using the case-listing procedure. Mann-Whitney U test, Chi-Square/Fisher’s exact test, and regression analyses were performed as appropriate. Statistical analyses were done using SEER*Stat 8.3.5 and R 3.6.1. RESULTS: Total of 3276 subjects with cervical cancer was included in this study; 155 subjects (4.7%) were uninsured. The rate for Non-Hispanic black (20.6% vs. 12.3%) and Hispanic (51.6% vs. 24.5%) race/ethnicity, Unmarried status (61.3% versus 54.8%) were higher in uninsured group (P<.05 for all). Before and after appropriate adjustments (for age, race/ethnicity, marital status and Medicaid-eligibility based on age >65) tumor sizes at the time of diagnosis [50 mm (28, 69) vs. 38 mm (15, 60); P=.04] was found to be larger in the uninsured group. CONCLUSION: Being uninsured is associated with having a larger tumor at the time of diagnosis of cervical cancer. An increase in insurance coverage and access to cancer screening for all women is essential.