Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.?

Authors

Juliana Morales, Herbert Werthiem College of Medicine, Florida InternationalFollow
Aaron Malles, Herbert Wertheim College of Medicine, Florida International UniversityFollow
Marrell Kimbell, Herbert Wertheim College of Medicine, Florida International UniversityFollow
Pura Rodríguez de la Vega, Herbert Wertheim College of Medicine, Florida International UniversityFollow
Grettel Castro, Herbert Wertheim College of Medicine, Florida International UniversityFollow
Alan M. Nieder, Herbert Wertheim College of Medicine, Florida International UniversityFollow
Noel C. Barengo, Herbert Wertheim College of Medicine, Florida International UniversityFollow

Date of this Version

9-13-2019

Document Type

Article

Abstract

Background: Scientific evidence on the effect of health insurance on racial disparities in urinary bladder cancer patients’ survival is scant. The objective of our study was to determine whether insurance status modifies the association between race and bladder cancer specific survival during 2007–2015. Methods: The 2015 database of the cancer surveillance program of the National Cancer Institute (n = 39,587) was used. The independent variable was race (White, Black and Asian Pacific Islanders (API)), the main outcome was cancer specific survival. Health insurance was divided into uninsured, any Medicaid and insured. An adjusted model with an interaction term for race and insurance status was computed. Unadjusted and adjusted Cox regression analysis were applied. Results: Health insurance was a statistically significant effect modifier of the association between race and survival. Whereas, API had a lower hazard of death among the patients with Medicaid insurance (HR 0.67; 95% CI 0.48–0.94 compared with White patients, no differences in survival was found between Black and White urinary bladder carcinoma patients (HR 1.24; 95% CI 0.95–1.61). This may be due a lack of power. Among the insured study participants, Blacks were 1.46 times more likely than Whites to die of bladder cancer during the 5-year follow-up (95% CI 1.30–1.64). Conclusions: While race is accepted as a poor prognostic factor in the mortality from bladder cancer, insurance status can help to explain some of the survival differences across races.

Comments

Originally published in International Journal of Environmental Research and Public Health.

Identifier

FIDC008119

Recommended Citation

Morales, Juliana; Malles, Aaron; Kimbell, Marrell; Rodríguez de la Vega, Pura; Castro, Grettel; Nieder, Alan M.; and Barengo, Noel C., "Does Health Insurance Modify the Association Between Race and Cancer-Specific Survival in Patients with Urinary Bladder Malignancy in the U.S.?" (2019). HWCOM Faculty Publications. 156.
https://digitalcommons.fiu.edu/com_facpub/156

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.