Delayed head and neck cancer detection and treatment by patient-insurance and community-level socioeconomic status.

Abstract

e18600 Background: Health insurance helps Head and Neck Cancer (HNC) patients overcome delays for accessing treatment. To overcome gaps in access, policymakers have expanded insurance coverage. If, however, access to timely treatment still varies by insurance status, disparities may persist. Methods: I analyzed data from the Surveillance Epidemiology and End Results program’s “Specialized HNC-HPV” datafile (2010-2016), which categorizes each HNC case into a socioeconomic status (SES) quintile based on the patient’s census-tract of residence. Patients were grouped by having private insurance, Medicare, Medicaid, or being uninsured. Two binary outcome variables were analyzed for differences by insurance status across SES quintiles: a distant stage diagnosis and initiating treatment at least two months after diagnosis. To account for the dynamic nature of HNC, the sample was stratified by Human Papilloma Virus (HPV)-association. Using a linear probability regression model, I tested for differences between insurance categories within each SES quintile. Results: Across all SES quintiles, HPV-negative cancer patients insured by Medicaid had higher rates of distant stage diagnoses and delayed treatment than privately insured patients. Uninsured patients also had higher rates of delayed detection and treatment initiation than privately insured patients. There were no significant differences in the rate of distant-stage diagnoses between privately insured and Medicare patients. However, for all SES quintiles, patients insured by Medicare had higher rates of delayed treatment than privately insured patients. Results were consistent for HPV-positive HNCs, but differences were not significant across all SES quintiles. Conclusions: Even after conditioning on community-level SES, a HNC patient’s insurance type may be associated with delayed detection and treatment. While expanding insurance remains a priority, policymakers must also improve the quality of public health insurance programs to ensure equitable access to timely HNC care.[Table: see text]