Insurance Status, Income Tied to Outcome in Pharyngeal SCC
Insurance status, median household income remain independent prognostic factors after adjustment
WEDNESDAY, July 5, 2017 (HealthDay News) -- For patients with squamous cell carcinoma (SCC) of the pharynx, insurance status and household income level are associated with outcome, according to a study published online June 29 in JAMA Otolaryngology-Head & Neck Surgery.
Jacob Y. Shin, M.D., from the Rush University Medical Center in Chicago, and colleagues analyzed data for 35,559 patients diagnosed with SCC of the pharynx from 2004 through 2013. The authors sought to examine the correlation between insurance and community-level socioeconomic status and outcome.
The researchers found that uninsured patients and Medicaid recipients were more likely to be younger, black, or Hispanic; to have lower median household income and educational attainment; to present with higher TNM (tumor, node, and metastasis) disease stages; and to start primary treatment later. Significantly better overall survival was seen for those with private insurance versus uninsured patients, Medicaid recipients, or Medicare recipients (hazard ratios, 1.72, 1.99, and 2.07, respectively), and for those with median household income of at least $63,000 compared with $48,000 to $62,999, $38,000 to $47,999, and less than $38,000 (hazard ratios, 1.19, 1.31, and 1.51, respectively). Even after accounting for educational attainment, race, Charlson/Deyo comorbidity score, disease site, and TNM stage of disease, insurance status and median household income remained independent prognostic factors for overall survival.
"Additional investigations are necessary to develop targeted interventions to optimize access to standard medical treatments, adherence to physician management recommendations, and subsequently, prognosis in these patients at risk," the authors write.