Mortality disparities in insured patients with cancer.

Abstract

150 Background: We examined mortality related to socioeconomic status (SES) in an insured Southern California population diagnosed with cancer and how healthcare settings can affect these differences. Methods: We identified adults diagnosed with the eight most common cancers from 2009-2014 from the California Cancer Registry and followed them through 2017. We calculated person-year mortality rates by SES and healthcare system (integrated healthcare system [IHS] or private insurance [PI]). Adjusted hazard ratios for the association between all-cause mortality and SES were estimated using Cox proportional hazards models accounting for covariates (race/ethnicity, demographics, stage, treatments). Results: The cohort was followed a maximum of 8 years. A total of 164,197 adults were diagnosed with cancers of the breast, prostate, lung, colon, melanoma, uterus, kidney and bladder (N=47,039 in IHS and N=117,158 in PI). In the whole cohort, we found an increased mortality risk between the highest and each of the lower SES quintiles. Specifically, the adjusted mortality risk was 16 to 37% greater in the lower SES groups as compared to the highest. We then examined the mortality in the IHS and PI groups separately. Overall mortality for all cancers combined was slightly lower in the IHS group (74.7/1,000 PY) than in the PI group (87.8/1,000 PY). In multivariable models, mortality risk was 6% to 16% greater in the lower SES groups versus the highest SES in the IHS population, while the risk was 19% to 45% greater in the lower SES groups in the PI population. Conclusions: Even among insured patients, and after multivariable adjustment, we found disparities in mortality in the lower SES groups. However, the magnitude of these differences was lower in patients cared for in IHS than those with PI. Preliminary data suggest that IHS may be well positioned to reduce disparity gaps in cancer outcomes. [Table: see text]