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

IF 9.9 1区 医学 Q1 ONCOLOGY JNCI Journal of the National Cancer Institute Pub Date : 2024-10-30 DOI:10.1093/jnci/djae242
Parichoy Pal Choudhury, Helmneh M Sineshaw, Rachel A Freedman, Michael T Halpern, Leticia Nogueira, Ahmedin Jemal, Farhad Islami
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Abstract

For many cancer sites, it is unclear to what extent differences in health insurance coverage contribute to racial and ethnic disparities in stage III-IV diagnoses. Using the National Cancer Database (1,893,026 patients aged 18-64 years, diagnosed between 2013-2019), 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 (ie, breast, prostate, colorectal, lung, cervical, uterine, bladder, head and neck, skin melanoma), detectable early through screening, physical examination, or clinical symptoms. The analyses provided evidence of mediation of non-Hispanic Black vs White disparities in eight cancers (range of proportions mediated: 4.5%-29.1%); Hispanic vs non-Hispanic White disparities in six cancers (13.2%-68.8%); non-Hispanic Asian/Pacific Islander vs White disparities in three cancers (5.8%-11.3%). To summarize, health insurance accounts for a significant proportion of the racial and ethnic disparities in stage III-IV diagnoses across a wide range of cancers.

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医疗保险对 10 种癌症晚期诊断中种族和民族差异的影响。
就许多癌症部位而言,目前尚不清楚医疗保险覆盖率的差异在多大程度上导致了III-IV期诊断中的种族和民族差异。我们利用全国癌症数据库(1,893,026 名年龄在 18-64 岁之间、在 2013-2019 年间确诊的患者),研究了医疗保险(私人保险与无保险)在解释 10 种癌症(即乳腺癌、前列腺癌、结直肠癌、肺癌、宫颈癌、子宫癌、膀胱癌、头颈部癌症、皮肤黑色素瘤)确诊时的种族和民族差异方面的潜在中介作用,这些癌症可通过筛查、体检或临床症状早期发现。分析结果表明,非西班牙裔黑人与白人在八种癌症中存在差异(差异比例范围:4.5%-29.1%);西班牙裔与非西班牙裔白人在六种癌症中存在差异(13.2%-68.8%);非西班牙裔亚洲/太平洋岛民与白人在三种癌症中存在差异(5.8%-11.3%)。总之,在各种癌症的 III-IV 期诊断中,医疗保险在种族和民族差异中占了很大比例。
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来源期刊
CiteScore
17.00
自引率
2.90%
发文量
203
审稿时长
4-8 weeks
期刊介绍: The Journal of the National Cancer Institute is a reputable publication that undergoes a peer-review process. It is available in both print (ISSN: 0027-8874) and online (ISSN: 1460-2105) formats, with 12 issues released annually. The journal's primary aim is to disseminate innovative and important discoveries in the field of cancer research, with specific emphasis on clinical, epidemiologic, behavioral, and health outcomes studies. Authors are encouraged to submit reviews, minireviews, and commentaries. The journal ensures that submitted manuscripts undergo a rigorous and expedited review to publish scientifically and medically significant findings in a timely manner.
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