Gerard A. Silvestri (
Ahmedin Jemal is senior vice president in the Surveillance and Health Equity Science Department, American Cancer Society, in Atlanta, Georgia.
Health Aff (Millwood). 2021 May;40(5):754-762. doi: 10.1377/hlthaff.2020.01839.
Proposals for expanding Medicare insurance coverage to uninsured Americans approaching the Medicare eligibility age of sixty-five has been the subject of intense debate. We undertook this study to assess cancer survival differences between uninsured patients younger than age sixty-five and older Medicare beneficiaries by using data from the National Cancer Database from the period 2004-16. The main outcomes were survival at one, two, and five years for sixteen cancer types in 1,206,821 patients. We found that uninsured patients ages 60-64 were nearly twice as likely to present with late-stage disease and were significantly less likely to receive surgery, chemotherapy, or radiotherapy than Medicare beneficiaries ages 66-69, despite lower comorbidity among younger patients. Compared with older Medicare patients, younger uninsured patients had strikingly lower five-year survival across cancer types. For instance, five-year survival in younger uninsured patients with late-stage breast or prostate cancer was 5-17 percent lower than that among older Medicare patients. We conclude that survival after a diagnosis of cancer is considerably lower in younger uninsured patients than in older Medicare patients. Expanding comprehensive health insurance coverage to people approaching Medicare age eligibility may improve cancer outcomes in the US.
将医疗保险范围扩大到接近 65 岁的 Medicare 参保年龄的无保险美国人的提议一直是激烈辩论的主题。我们进行这项研究是为了评估在 2004-16 年期间使用国家癌症数据库的数据，比较 65 岁以下无保险患者和年龄较大的 Medicare 受益人的癌症生存差异。主要结果是在 1,206,821 名患者中 16 种癌症的一年、两年和五年生存率。我们发现，60-64 岁的无保险患者晚期疾病的发病率几乎是 66-69 岁 Medicare 受益人的两倍，尽管年轻患者的合并症较少，但接受手术、化疗或放疗的可能性明显低于 Medicare 受益人。与年龄较大的 Medicare 患者相比，年轻的无保险患者在所有癌症类型中五年生存率明显较低。例如，晚期乳腺癌或前列腺癌的年轻无保险患者的五年生存率比老年 Medicare 患者低 5-17%。我们得出的结论是，与老年 Medicare 患者相比，诊断癌症后年轻的无保险患者的生存率明显较低。将全面健康保险覆盖范围扩大到接近 Medicare 年龄资格的人群可能会改善美国的癌症结局。
