Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and...

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Vydáno v:	JNCI : Journal of the National Cancer Institute Ročník 112; číslo 7; s. 671
Hlavní autoři:	Yabroff, K Robin, Reeder-Hayes, Katherine, Zhao, Jingxuan, Halpern, Michael T, Lopez, Ana Maria, Bernal-Mizrachi, Leon, Collier, Anderson B, Neuner, Joan, Phillips, Jonathan, Blackstock, William, Patel, Manali
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.07.2020
Témata:	Early Detection of Cancer - statistics & numerical data Health Services Accessibility - statistics & numerical data Humans Insurance Coverage - statistics & numerical data Insurance, Health - statistics & numerical data Medicaid - statistics & numerical data Medically Uninsured - statistics & numerical data Neoplasms - diagnosis Neoplasms - economics Neoplasms - therapy Observational Studies as Topic Patient Protection and Affordable Care Act - statistics & numerical data Poverty - statistics & numerical data Publications - statistics & numerical data United States United States
ISSN:	1460-2105, 1460-2105
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Abstract	Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.
AbstractList	Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival.BACKGROUNDLack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival.We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively.METHODSWe conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively.Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions.RESULTSStudies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions.Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.CONCLUSIONSHealth insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes. Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.
Author	Lopez, Ana Maria Collier, Anderson B Halpern, Michael T Phillips, Jonathan Bernal-Mizrachi, Leon Patel, Manali Neuner, Joan Zhao, Jingxuan Yabroff, K Robin Reeder-Hayes, Katherine Blackstock, William
Author_xml	– sequence: 1 givenname: K Robin surname: Yabroff fullname: Yabroff, K Robin organization: Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA – sequence: 2 givenname: Katherine surname: Reeder-Hayes fullname: Reeder-Hayes, Katherine organization: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA – sequence: 3 givenname: Jingxuan surname: Zhao fullname: Zhao, Jingxuan organization: Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA – sequence: 4 givenname: Michael T surname: Halpern fullname: Halpern, Michael T organization: Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA – sequence: 5 givenname: Ana Maria surname: Lopez fullname: Lopez, Ana Maria organization: Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA – sequence: 6 givenname: Leon surname: Bernal-Mizrachi fullname: Bernal-Mizrachi, Leon organization: Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA – sequence: 7 givenname: Anderson B surname: Collier fullname: Collier, Anderson B organization: Children's Cancer Center, The University of Mississippi Medical Center, Jackson, MS, USA – sequence: 8 givenname: Joan surname: Neuner fullname: Neuner, Joan organization: Medical College of Wisconsin, Milwaukee, WI, USA – sequence: 9 givenname: Jonathan surname: Phillips fullname: Phillips, Jonathan organization: American Society of Clinical Oncology, Alexandria, VA, USA – sequence: 10 givenname: William surname: Blackstock fullname: Blackstock, William organization: Wake Forest School of Medicine, Winston-Salem, NC, USA – sequence: 11 givenname: Manali surname: Patel fullname: Patel, Manali organization: Stanford University School of Medicine, Stanford, CA, USA
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SubjectTerms	Early Detection of Cancer - statistics & numerical data Health Services Accessibility - statistics & numerical data Humans Insurance Coverage - statistics & numerical data Insurance, Health - statistics & numerical data Medicaid - statistics & numerical data Medically Uninsured - statistics & numerical data Neoplasms - diagnosis Neoplasms - economics Neoplasms - therapy Observational Studies as Topic Patient Protection and Affordable Care Act - statistics & numerical data Poverty - statistics & numerical data Publications - statistics & numerical data United States
Title	Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research
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