Insurance disparity in cardiovascular mortality among non-elderly cancer survivors

Authors

Tiantian Shi, Department of Medicine, Bridgeport Hospital, Bridgeport, CT, USA.
Changchuan Jiang, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.Follow
Cenjing Zhu, Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, CT, USA.
Fangcheng Wu, Department of Medicine, Memorial Hospital West, Pembroke Pines, FL, USA.
Irma Fotjhadi, Division of Cardiovascular Medicine, Bridgeport Hospital, 267 Grant St, Bridgeport, CT, 00610, USA.
Stuart Zarich, Division of Cardiovascular Medicine, Bridgeport Hospital, 267 Grant St, Bridgeport, CT, 00610, USA. pszari@bpthosp.org.

Document Type

Article

Publication Title

Cardio-oncology (London, England)

Abstract

BACKGROUND: Insurance status plays a vital role in cancer diagnosis, treatments and survival. Cancer patients have higher cardiovascular disease (CVD) mortality than the general population. METHODS: The Surveillance, Epidemiology and End Results (SEER) program 2007-2016 was used to estimate the CVD mortality among cancer patients aged 18 to 64 years at the time of diagnosis of an initial malignancy with the eight most prevalent cancers. Standardized mortality ratios (SMRs) were calculated for each insurance (Non-Medicaid vs Medicaid vs Uninsured) using coded cause of death from CVD with adjustment of age, race, and gender. The Fine-Grey Model was used to estimate adjusted Hazard Ratios (HR) of each insurance in CVD mortality. RESULTS: A total of 768,055 patients were included in the final analysis. CVD death in patients with Medicaid insurance remained higher than in those with Non-Medicaid insurance (HR = 1.71; 95%CI, 1.61-1.81; p < 0.001). Older age, male gender, and black race were all associated with increased CVD mortality in the multivariable model. Compared to the general population, patients with Medicaid had the highest SMRs of CVD mortality, regardless of year of cancer diagnosis, follow-up time, cancer site, and race. Non-Medicaid insured patients had similar CVD mortality to the general population after 2 years out from their cancer diagnosis. CONCLUSION: Cancer patients with Non-Medicaid insurance have significantly lower CVD mortality than those with no insurance or Medicaid. The insurance disparity remained significant regardless of type of CVD, cancer site, year of diagnosis and follow-up time.

First Page

11

DOI

10.1186/s40959-021-00098-8

Publication Date

3-20-2021

Recommended Citation

Shi, Tiantian; Jiang, Changchuan; Zhu, Cenjing; Wu, Fangcheng; Fotjhadi, Irma; and Zarich, Stuart, "Insurance disparity in cardiovascular mortality among non-elderly cancer survivors" (2021). Cardiology. 6.
https://scholar.bridgeporthospital.org/cardiology/6

Identifier

33743837 (pubmed); PMC7980587 (pmc); 10.1186/s40959-021-00098-8 (doi); 10.1186/s40959-021-00098-8 (pii)