Background

Uninsured adolescents and young adults (AYAs) and those with publicly funded health insurance are more likely to be diagnosed with cancer at later stages. However, prior population-based studies have not distinguished between AYAs who were continuously uninsured from those who gained Medicaid coverage at the time of cancer diagnosis.

Methods

AYA patients (ages 15–39 years) with nine common cancers diagnosed from 2005 to 2014 were identified using California Cancer Registry data. This cohort was linked to California Medicaid enrollment files to determine continuous enrollment, discontinuous enrollment, or enrollment at diagnosis, with other types of insurance determined from registry data. Multivariable logistic regression was used to evaluate factors associated with later stages at diagnosis.

Results

The majority of 52 774 AYA cancer patients had private or military insurance (67.6%), followed by continuous Medicaid (12.4%), Medicaid at diagnosis (8.5%), discontinuous Medicaid (3.9%), other public insurance (1.6%), no insurance (2.9%), or unknown insurance (3.1%). Of the 13 069 with Medicaid insurance, 50.1% were continuously enrolled. Compared to those who were privately insured, AYAs who enrolled in Medicaid at diagnosis were 2.2–2.5 times more likely to be diagnosed with later stage disease, whereas AYAs discontinuously enrolled were 1.7–1.9 times and AYAs continuously enrolled were 1.4–1.5 times more likely to be diagnosed with later stage disease. Males, those residing in lower socioeconomic neighborhoods, and AYAs of Hispanic or black race and ethnicity (vs non-Hispanic white) were more likely to be diagnosed at a later stage, independent of insurance.

Conclusions

Our findings suggest that access to continuous medical insurance is important for decreasing the likelihood of late stage cancer diagnosis.

中文翻译：

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在青少年中，健康保险对癌症诊断阶段的影响。

背景

未保险的青少年和年轻人（AYAs）以及那些拥有公共资助的健康保险的人在以后的阶段更容易被诊断出患有癌症。但是，以前的基于人群的研究并未区分在癌症诊断时一直没有保险的AYA和那些获得医疗补助的AYA。

方法

2005年至2014年期间，被诊断出患有9种常见癌症的AYA患者（年龄在15-39岁之间）使用加利福尼亚癌症登记数据进行了识别。该队列与加利福尼亚医疗补助登记文件相关联，以确定连续登记，不连续登记或诊断时登记，其他类型的保险则根据登记数据确定。多变量logistic回归用于评估与诊断后期有关的因素。

结果

52774名AYA癌症患者中的大多数拥有私人或军事保险（67.6％），其次是连续医疗补助（12.4％），诊断医疗补助（8.5％），非连续医疗补助（3.9％），其他公共保险（1.6％），没有保险（2.9％）或未知保险（3.1％）。在13069份医疗补助保险中，有50.1％持续注册。与私人保险的人相比，在诊断时加入医疗补助的AYA被诊断出患有晚期疾病的可能性高2.2-2.5倍，而不连续的AYA则被诊断出患有疾病的可能性高1.7-1.9倍，而连续参与的AYA的被诊断可能性高1.4-1.5倍。被诊断为晚期疾病。男性，居住在较低社会经济街区的人以及西班牙裔或黑人种族和种族的AYA（相对于非西班牙裔白人）更容易在以后被诊断出来，

结论

我们的研究结果表明，获得持续医疗保险对于降低晚期癌症诊断的可能性非常重要。