Insurance Status Effect on Laryngeal Cancer Survival: A Population Based Study.

OBJECTIVE

To analyze insurance status effect on overall survival (OS) and disease-specific survival (DSS) in laryngeal cancer.

STUDY DESIGN

Cross-sectional population analysis.

SETTING

Surveillance, Epidemiology, and End Results (SEER) database.

PARTICIPANTS

Laryngeal cancer patients from 2007 to 2016.

MAIN OUTCOME MEASURES

Kaplan-Meier method with log-rank statistic analyzed OS and DSS by insurance status. Multivariable cox proportional hazard modeling generated survival prognostic factors.

RESULTS

Of 19 667 laryngeal cancer cases, initial disease presentation was stage I: 7770 patients (39.5%), stage II: 3337 patients (17.0%), stage III: 3289 patients (16.7%), and stage IV: 5226 patients (26.6%). Patients had non-Medicaid insurance (15 523, 78.9%), had Medicaid (3306, 16.8%), or were uninsured (891, 4.5%). Mean and median OS for insured, Medicaid, and uninsured patients were 60.5, 49.6, and 56.6 and 74.0, 40.0, and 65.0 months, respectively. Following multivariable analysis, OS for insured, Medicaid, and uninsured patients was stage I: 87.9, 82.8, and 88.4 ( < .001), stage II: 79.1, 75.1, and 78.3 ( = .12), stage III: 68.7, 66.1, and 72.1 ( = .11), and stage IV: 57.1, 51.7, and 50.3 ( < .001) months. DSS mean survival times were 77.0, 65.8, and 67.7 months ( < .001) for insured, Medicaid, and uninsured patients. Age (HR: 1.02/year,  < .001) and black (HR: 1.15,  = .001) compared to white race predicted worse survival. Compared to insured status, Medicaid insurance carried a death hazard ratio of 1.40 ( < .001) and uninsured status had a death hazard ratio of 1.40 ( < .001).

CONCLUSION

Insured laryngeal cancer patients had prolonged OS and DSS compared to Medicaid and uninsured patients. Medicaid patients had equivalent survival outcomes to uninsured patients.

LEVEL OF EVIDENCE

2c.