Influence of sociodemographic factors on time to diagnosis and treatment among members of a large national payor diagnosed with lung cancer.

Abstract

e23048 Background: Diagnostic and treatment delays may be associated with later stage lung cancer diagnosis. This study explores the time from lung cancer screening to biopsy and biopsy to treatment in members of a national health plan diagnosed with lung cancer. Methods: De-identified administrative records of Medicare, Medicaid and Commercial fully-insured (C-FI) members with a claim for lung cancer between January 2020 and December 2022 were retrospectively analyzed. Poisson regression modeling determined duration (days) from screening to biopsy and biopsy to treatment initiation by insurance type group controlling for covariates. Between-group differences in duration was estimated by exponentiating the model estimate and converting to a percentage change, which was then applied to the mean days to event. Time-to-event modelling was conducted with Cox Proportional and Aelen’s Additive Hazard models. P< 0.05 was considered significant. Results: 8,221 members (C-FI: 402; Medicare: 7,103; Medicaid: 716) with a diagnosis of lung cancer were evaluated. Mean duration between screening and biopsy was 34.3 days (95% confidence interval [CI]: 32.8-35.8). Compared to C-FI members, Medicaid and Medicare members experienced shorter duration between screening to biopsy by -14.0 days (95% CI: 13.1-14.9) and -18.9 days (95% CI: 18.2-19.5), respectively (both P< 0.0001). Gender, language, age, and race were associated with time to biopsy (all P< 0.001). Mean duration between biopsy and treatment was 37.9 days (95% CI: 36.8-39.0). Compared to C-FI members, Medicare and Medicaid members experienced a longer duration between biopsy to treatment by +14.6 days (95% CI: 12.1-17.3) and +22.5 days (95% CI: 19.4-25.8), respectively (both P< 0.0001). Compared to C-FI members, Medicaid members had a higher risk of not receiving treatment (Hazard ratio [HR] = 0.831; 95% CI: 0.735-0.939; P= 0.003). Among the total sample, males were more likely to receive treatment at any time compared to females (HR = 1.067; 95% CI: 1.021-1.114; P= 0.0035). Conclusions: This real-world evaluation suggests that insurance type is associated with the timeline of screening to biopsy and biopsy to treatment initiation. Medicaid and Medicare members had a shorter time from screening to biopsy compared to C-FI; however, a longer duration from biopsy to treatment initiation was experienced. Future studies will explore if these differences translate to variations in health outcomes and identify potential interventions that aim to improve time from biopsy to treatment initiation.