P10.03 Health Insurance Coverage and Racial Disparities in Early-Stage Detection and Treatment of Lung Cancer: A Causal Mediation Analysis

Abstract

Racial minority patients were more likely to be diagnosed an advanced-stage disease at presentation, and received less cancer-directed surgery and other standard care. We hypothesized that access to adequate health insurance coverage among patients with lung cancer play an important role in these racial disparities, because many previous studies have shown a significant association between lack of insurance status and poor cancer outcomes. A total of 346,733 patients with lung cancer diagnosed between 2007-2015 from the Surveillance, Epidemiology, and End Results 18 registry were enrolled in our analyses. We conducted univariate and multivariate and logistic regressions to assess the association between race and the risk of being diagnosed at advanced-stage lung cancer (AJCC stage III, or IV), receipt of cancer-direct surgery and no treatment. Mediation analyses were conducted to quantify the proportion of which health insurance coverage is a factor in these racial disparities of lung cancer outcomes. Patients from Asian or Pacific Islander, NHB, and Hispanic were more likely to present with advanced-stage lung cancer compared with NHW patients. About 10-20% of the disparity between patients from racial/ethnic minority and NHW could be explained by having no insurance or only Medicaid. Cancer-directed surgery was less conducted for racial/ethnic minorities than NHW patients. Over 30% of the effect was mediated by the insurance status for Asian or Pacific Islander and Hispanic patients. Patients from and Hispanic received significantly less treatment than NHW patients, and up to 36% and 42% of the total effect was mediated by lack of insurance or having Medicaid for NHB and Hispanic separately. Our study found that health insurance significantly affects the racial disparities of advanced-stage lung cancer detection and receipt of cancer-direct surgery and other treatment. Narrowing the racial disparities might require expansion of access to adequate insurance coverage.