Year of Publication

2018

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Sarah Wackerbarth

Committee Member

Dr. Steven Fleming

Committee Member

Dr. Li Chen

Committee Member

Dr. Warren J. Christian

Abstract

Introduction Objective of the study was to explore the impact of health insurance and socio-demographic factors on survival for breast cancer patients in Kentucky. Breast cancer is the most prevalent cancer among women in the US. Breast cancer survival is affected by various factors including health insurance, residence, age, race, geographical distance, income.

Methods The data were obtained from Kentucky Cancer Registry and included 47,128 women diagnosed with primary breast cancer between 2000 to 2014. The relationship of health insurance and other socio-demographic factors was analyzed using Cox regression.

ResultsThe overall five-year survival proportion was 0.97, 0.76 and 0.71 respectively for privately insured, Medicaid and Medicare patients. Medicaid and Medicare patients had 1.89 (95% CI, 1.71-2.10), 1.96 (95% CI, 1.75-2.18) times higher hazard of dying respectively compared to privately insured patients. Patients who had no family history of breast cancer had a 15% (HR=1.15, p-value < 0.001) higher hazard of dying compared to those having family history of breast cancer. Tobacco use and marital status also had significant effect on patient’s survival. Other tumor related and biological factors were also included in the regression model. Sub group analysis by SEER summary stage also showed that Medicaid and Medicare patients significantly at disadvantage compared to privately insured patients for both in-situ and regional stage groups. Medicaid patients had 1.41 (HR=1.41, p-value=0.0020) times higher hazard of death compared to privately insured patients whereas Medicare patients and the privately insured patients had no difference in hazard of death for distant stage group. Sub group analysis by age group also showed Medicare and Medicaid patients are disadvantaged compared to privately insured patients for all age groups.

Conclusion This study found that Medicaid and Medicare patients had higher hazard of dying compared to privately insured patients. This helps to inform public health professionals and policy makers for advocacy and design policies that bring equal health outcomes regardless of insurance types.

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