Acute myeloid leukemia: how the uninsured fare.

BACKGROUND: African American race and uninsurance are associated with undertreatment and poor survival in solid tumor cancers. This relationship has not been examined in acute myeloid leukemia (AML) where absence of treatment or treatment delays can result in death within weeks or months. Induction followed by consolidation treatment, in contrast, has a high probability for remission or cure. We examined the relationship between race and health insurance and inpatient chemotherapy and survival in AML patients between the ages of 21 and 64 years. We also examined inpatient costs associated with inpatient treatment. METHODS: We used population-based data from the Virginia Cancer Registry and the Virginia Health Information discharge data for patients diagnosed with AML between 1999 and 2006 (n = 523). Adjusted logistic regression was used to measure the relationship between the independent variables and chemotherapy. We used the Cox proportional hazards method to estimate survival. RESULTS: Uninsured patients were more likely to be untreated than their privately insured counterparts (odds ratio, 4.40; 95% confidence interval, 1.85-10.49) and had a higher likelihood of death (hazard ratio, 1.29; 95% confidence interval, 1.02-1.84). Once treatment was adjusted in the survival analyses, differences between insurance groups were not statistically significant. The median 1-year cost of inpatient care following diagnosis for patients who received chemotherapy exceeded $100,000. CONCLUSION: This study addressed the urgency for health insurance that affords access to care. Without treatment, the outcome of AML is death within only a few months; with treatment, the chance for long-term remission or even cure exists.

Differences in breast cancer diagnosis and treatment: experiences of insured and uninsured women in a safety-net setting.

To explore how well the safety net performs at eliminating differences in diagnosis and treatment of insured and uninsured women with breast cancer, we compared insured and uninsured women treated in a safety-net setting. Controlling for socioeconomic characteristics, uninsured women are more likely to be diagnosed with advanced disease, requiring more extensive treatment relative to insured women, and also experience delays in initiating and completing treatment. The findings suggest that, despite the safety-net system, uninsured women with breast cancer are likely to require more costly treatment and to have worse outcomes relative to insured women with breast cancer.

Surgery wait times and specialty services for insured and uninsured breast cancer patients: does hospital safety net status matter?

OBJECTIVE: To determine whether safety net and non-safety net hospitals influence inpatient breast cancer care in insured and uninsured women and in white and African American women. DATA SOURCES: Six years of Virginia Cancer Registry and Virginia Health Information discharge data were linked and supplemented with American Hospital Association data. STUDY DESIGN: Hierarchical generalized linear models and linear probability regression models were used to estimate the relationship between hospital safety net status, the explanatory variables, and the days from diagnosis to mastectomy and the likelihood of breast reconstruction. PRINCIPAL FINDINGS: The time between diagnosis and surgery was longer in safety net hospitals for all patients, regardless of insurance source. Medicaid insured and uninsured women were approximately 20 percent less likely to receive reconstruction than privately insured women. African American women were less likely to receive reconstruction than white women. CONCLUSIONS: Following the implementation of health reform, disparities may potentially worsen if safety net hospitals' burden of care increases without commensurate increases in reimbursement and staffing levels. This study also suggests that Medicaid expansions may not improve outcomes in inpatient breast cancer care within the safety net system.