Insurance status and survival among prostate cancer patients: A population-based study.

Abstract

e16563 Background: This population-based study assesses the relationship between insurance status and survival outcomes among men with prostate cancer diagnosed before 65 years of age. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 114,871 prostate cancer patients diagnosed before age 65 in 2007-2013. Insurance type was classified as uninsured, Medicaid, and other (including private insurance and coverage from the military or veterans affairs). Disease risk group was based on the NCCN criteria. We used multivariable Cox proportional hazards models to estimate the relative risks of all-cause mortality and prostate cancer specific mortality (PCSM), adjusted by age, race, marital status, region, diagnosis period, and primary treatment. Results: Compared with patients with other insurance, Medicaid and uninsured patients experienced 103% and 41% higher all-cause mortality. The corresponding increase for PCSM were 61% and 32%. Medicaid patients experienced 44% (HR=1.44, 95% 1.25-1.65) higher all-cause mortality than uninsured patients. Table 1 provides data stratified by risk status at diagnosis. Conclusions: Uninsured and Medicaid patients experienced higher PCSM and all-cause mortality compared to other insured patients across all disease severity. Medicaid patients experienced worse all-cause mortality compared with uninsured patients. Further studies are warranted to investigate factors related to poor survival outcomes among uninsured and Medicaid patients. [Table: see text]