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  • Title: Association of health insurance with outcomes in adults ages 18 to 64 years with melanoma in the United States.
    Author: Amini A, Rusthoven CG, Waxweiler TV, Jones BL, Fisher CM, Karam SD, Raben D.
    Journal: J Am Acad Dermatol; 2016 Feb; 74(2):309-16. PubMed ID: 26670715.
    Abstract:
    BACKGROUND: Studies evaluating insurance status and melanoma outcomes are limited. OBJECTIVE: We investigated whether health insurance correlates with more advanced disease, receipt of treatment, and survival in melanoma. METHODS: This was a cross-sectional analysis of 61,650 patients with cutaneous melanoma using the Surveillance, Epidemiology, and End Results database. RESULTS: Under multivariate analysis, patients with either Medicaid insurance (hazard ratio, 1.83; 95% confidence interval [CI], 1.65-2.04; P < .001) or uninsured status (hazard ratio, 1.63; 95% CI, 1.44-1.85; P < .001) were more likely to die of any cause, including melanoma. Uninsured compared with non-Medicaid insured cases more often presented with increasing tumor thickness (odds ratio [OR], 2.19; 95% CI, 1.76-2.73; P < .001) and presence of ulceration (OR, 1.64; 95% CI, 1.40-1.92; P < .001), and less often received treatment (OR, 1.87; 95% CI, 1.60-2.19; P < .001). Compared with non-Medicaid insured, Medicaid cases more often had increasing tumor thickness (OR, 2.36; 95% CI, 1.91-2.91; P < .001), advanced stage (OR, 1.59; 95% CI, 1.37-1.85; P < .001), and presence of ulceration (OR, 1.40; 95% CI, 1.19-1.63; P < .001), and less often received treatment (OR, 1.61; 95% CI, 1.37-1.89; P < .001). LIMITATIONS: This was a retrospective study. CONCLUSION: Patients with melanoma and Medicaid or uninsured status were more likely to present with advanced disease and were less likely to receive treatment, likely contributing to an overall and cause-specific survival detriment. Addressing access to care may help improve these outcomes.
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