TY - JOUR
T1 - Impact of Insurance on Overall Survival in Acute Lymphoblastic Leukemia
T2 - A SEER Database Study
AU - Joshi, Utsav
AU - Khanal, Shital
AU - Bhetuwal, Uttam
AU - Bhattarai, Adheesh
AU - Dhakal, Prajwal
AU - Bhatt, Vijaya Raj
N1 - Funding Information:
Vijaya Raj Bhatt reports receiving consulting fees from Genentech, Rigel, Incyte, Servier Pharmaceuticals LLC, Partnership for health analytic research, LLC (which in turn, receives funds from Jazz Pharmaceuticals) and Abbvie, research funding (institutional) from Abbvie, Pfizer, Incyte, Jazz, Tolero Pharmaceuticals, Inc, and National Marrow Donor Program, drug support (institutional) from Oncoceutics for a trial.
Publisher Copyright:
© 2022
PY - 2022/7
Y1 - 2022/7
N2 - Introduction: Insurance status at diagnosis remains an important barrier to health care access and adherence to treatment. Here, we aim to assess the impact of insurance status, and age on overall survival (OS) in patients with acute lymphoblastic leukemia (ALL). Materials and methods: Using the Surveillance, Epidemiology, and End Results database, we identified all patients younger than 65 years of age diagnosed with ALL from 2010 to 2016. OS was estimated for each group using the Kaplan Meier curves and compared based on insurance type using a log-rank test. Multivariate analysis using Cox proportional hazard regression model was used to assess the effect of insurance status on OS. Results: A total of 9057 patients were included in the analysis. Medicaid beneficiaries had worse 5-year OS than insured patients (HR 1.33, 95% CI 1.08-1.63, P = .006) in 0-18 years age group. Despite chemotherapy, patients older than 18 years showed poor OS in all insurance categories. Patients on Medicaid showed inferior OS compared to insured in 19-40 years (HR 1.46, 95% CI 1.21-1.76, P < .001) and 41-65 years age group (HR 1.27, 95% CI 1.09-1.49, P = .003). Interestingly, no significant difference was observed in the OS between the Medicaid and uninsured groups in each age category. Conclusion: Our large database study demonstrates that insured status is associated with better OS in ALL across all age groups. Further studies to develop effective strategies to bridge health care disparities areessential.
AB - Introduction: Insurance status at diagnosis remains an important barrier to health care access and adherence to treatment. Here, we aim to assess the impact of insurance status, and age on overall survival (OS) in patients with acute lymphoblastic leukemia (ALL). Materials and methods: Using the Surveillance, Epidemiology, and End Results database, we identified all patients younger than 65 years of age diagnosed with ALL from 2010 to 2016. OS was estimated for each group using the Kaplan Meier curves and compared based on insurance type using a log-rank test. Multivariate analysis using Cox proportional hazard regression model was used to assess the effect of insurance status on OS. Results: A total of 9057 patients were included in the analysis. Medicaid beneficiaries had worse 5-year OS than insured patients (HR 1.33, 95% CI 1.08-1.63, P = .006) in 0-18 years age group. Despite chemotherapy, patients older than 18 years showed poor OS in all insurance categories. Patients on Medicaid showed inferior OS compared to insured in 19-40 years (HR 1.46, 95% CI 1.21-1.76, P < .001) and 41-65 years age group (HR 1.27, 95% CI 1.09-1.49, P = .003). Interestingly, no significant difference was observed in the OS between the Medicaid and uninsured groups in each age category. Conclusion: Our large database study demonstrates that insured status is associated with better OS in ALL across all age groups. Further studies to develop effective strategies to bridge health care disparities areessential.
KW - ALL
KW - Age
KW - Health care disparity
KW - Sociodemographic factors
KW - Survival outcome
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U2 - 10.1016/j.clml.2022.01.001
DO - 10.1016/j.clml.2022.01.001
M3 - Article
C2 - 35125333
AN - SCOPUS:85124018310
SN - 2152-2669
VL - 22
SP - e477-e484
JO - Clinical Lymphoma, Myeloma and Leukemia
JF - Clinical Lymphoma, Myeloma and Leukemia
IS - 7
ER -