Contribution of health insurance to racial and ethnic disparities in advanced-stage diagnosis of 10 cancers.

Abstract

For many anatomic cancer sites, it is unclear to what extent differences in health insurance coverage contribute to racial and ethnic disparities in the diagnosis of stage III and IV disease. Using the National Cancer Database (1 893 026 patients aged 18-64 years, diagnosed between 2013 and 2019), we investigated a potential mediating role of health insurance (privately insured vs uninsured) in explaining racial and ethnic disparities in stage at diagnosis of 10 cancers-breast (female), prostate, colorectum, lung, cervix, uterus, stomach, urinary bladder, head and neck, and skin melanoma- detectable early through screening, physical examination, or clinical symptoms. The analyses provided evidence of mediation of disparities among non-Hispanic Black vs White individuals in 8 cancers (range of proportions mediated: 4.5%-29.1%), in Hispanic vs non-Hispanic White individuals in 6 cancers (13.2%-68.8%), and in non-Hispanic Asian or Pacific Islander vs White individuals in 3 cancers (5.8%-11.3%). To summarize, health insurance accounts for a statistically significant proportion of the racial and ethnic disparities in diagnosis of stage III and IV disease across a range of cancer types.