The gap between the haves and have-nots continues to grow, and medicine is no exception. In the latest chapter, a study found that the gap in cancer survival rates between those with private insurance and those without has grown over the past two decades.
In some cases, uninsured patients were half as likely to survive as those who carried private insurance. While patients under Medicare tended to fare better, those with other public insurance — usually Medicaid — had worse outcomes, according to a piece published in JAMA Oncology by Libby Ellis, PhD, of the Cancer Prevention Institute of California in Fremont and colleagues.
For the study, the researchers used data from the California Cancer Registry to estimate survival rates in three calendar periods ranging from 1997 through December 2014. Overall, the data included information on over 1 million patients diagnosed with melanoma, breast, prostate, colorectal or lung cancer.
The results couldn’t have been more stark.
“Examination of the survival trends revealed that improvements in survival from January 1997 to December 2014 were almost exclusively limited to patients with private or Medicare insurance,” the authors wrote. “For patients with other public or no insurance, survival was often stubbornly unchanged, or in some cancers, declining.”
Those overall trends weren’t evident in all cancers. For example, survival in patients with lung cancer went up for all groups except for the uninsured. Colorectal cancer saw improvements for those with private insurance. Some of the biggest disparities came from melanoma. Among men diagnosed from 2009 to 2014, mortality was 92% higher for uninsured men than those with private insurance. Men with other public insurance still saw 37% higher mortality rates than those with private insurance.
The disparity between uninsured women with breast cancer and those with private insurance also grew, from 45% from 1997-2002 to 72% from 2009-2014.
Some of the disparity is likely due to early detection. Patients with Medicaid or no insurance are less likely to come in during the early stages of disease, the authors wrote.