Impact of Insurance on Overall Survival in Acute Lymphoblastic Leukemia: A SEER Database Study

Authors

Utsav Joshi, Rochester Regional HealthFollow
Shital Khanal, Department of Internal Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
Uttam Bhetuwal, Department of Kidney and Hypertension, Rhode Island Hospital, Providence, RI.
Adheesh Bhattarai, Department of Internal Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
Prajwal Dhakal, Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA.
Vijaya Raj Bhatt, Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE.

Department

Internal Medicine

Document Type

Article

Publication Title

Clinical Lymphoma, Myeloma & Leukemia

Abstract

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 are essential.

First Page

e477

Last Page

e484

DOI

10.1016/j.clml.2022.01.001

Volume

22

Issue

7

Publication Date

7-2022

PubMed ID

35125333

Recommended Citation

Joshi, U., Khanal, S., Bhetuwal, U., Bhattarai, A., Dhakal, P., & Bhatt, V. R. (2022). Impact of Insurance on Overall Survival in Acute Lymphoblastic Leukemia: A SEER Database Study. Clinical Lymphoma, Myeloma & Leukemia, 22 (7), e477-e484. https://doi.org/10.1016/j.clml.2022.01.001