Impact of Insurance and Income levels on Survival Rates in Prolactinomas

Abstract

<h3>Purpose/Objective(s)</h3> Prolactinoma is the most common type (∼40%) of functional pituitary adenoma. Patients with prolactinoma generally have a good prognosis with appropriate treatment. However, disparities in insurance and socioeconomic status can influence the outcomes of illnesses that have good prognoses. This study aims to analyze the impact of insurance and socioeconomic status on the survival rates of prolactinoma patients across the United States. <h3>Materials/Methods</h3> Patients with prolactinomas diagnosed from 2004 to 2016 were identified from the National Cancer Database (NCDB). Patients with the histology code 8271 in the target area C75.1 (pituitary gland) were included. Patients with unknown status for age, sex, race, insurance status, income quartile, Charlson-Deyo comorbidity score, treatment modality, or overall survival (OS) were excluded. OS was evaluated with the Kaplan-Meier and Cox proportional hazards methods. <h3>Results</h3> A total of 2391 patients with prolactinomas were identified. The median age was 38 years. 8.1% of patients were uninsured, 64.5% of patients had private insurance or managed care. 13.5% of patients had Medicaid, 12.0% of patients had Medicare, and 1.8% of patients had other government insurance. 72.9% of patients were white, and 19.8% of patients were from households in the lowest income quartile based on 2016 US census data. Using univariate analysis, only median household income quartile was statistically associated with OS: patients in the lowest income quartile (less than $40,277 annually) were associated with poorer OS (HR 1.596, 95% CI 1.03-2.48, <i>P</i> < 0.05) compared to patients in higher income quartiles. With multivariate analysis adjusting for age, sex, race, Charlson-Deyo comorbidity score, and insurance status, statistically significant differences in OS were seen for patients in the lowest income quartile (HR 1.993, 95% CI 1.24-3.21, <i>P</i> < 0.05) compared to patients in higher income quartiles. Poorer outcomes were also associated with older age at diagnosis (HR 1.063, 95% CI 1.05-1.08, <i>P</i> < 0.05) and female sex (HR 1.600, 95% CI 1.12-2.31, <i>P</i> < 0.05). <h3>Conclusion</h3> This NCDB study demonstrates the statistically significant disparity in outcomes for prolactinoma patients in the lower income quartile levels. Since prolactinomas represent the most common form of pituitary tumors, it is important to recognize the impact of income disparity on outcomes and develop strategies to improve clinical outcome for these patients.