Department of Internal Medicine, Dell Medical School.
LIVESTRONG Cancer Institutes, The University of Texas at Austin, Austin, TX.
Med Care. 2023 Dec 1;61(12):829-835. doi: 10.1097/MLR.0000000000001921. Epub 2023 Sep 13.
Previous studies of hospital-based patients with metastatic melanoma suggest sociodemographic factors, including insurance type, may be associated with the receipt of systemic treatments.
To examine whether insurance type is associated with the receipt of systemic treatment among patients with melanoma in a broad cohort of patients in North Carolina.
We conducted a retrospective cohort study between 2011 and 2017 of patients with stages III-IV melanoma using data from the North Carolina Central Cancer Registry linked to Medicare, Medicaid, and private health insurance claims across the state. The primary outcome was the receipt of any systemic treatment, and the secondary outcome was the receipt of immunotherapy.
A total of 372 patients met the inclusion criteria. The average age was 68 years old (interquartile range: 56-76) and 61% were male. Within the cohort 48% had Medicare only, 29% had private insurance, 12% had both Medicare and Medicaid, and 11% had Medicaid only. A total of 186 (50%) patients received systemic treatment for melanoma, 125 (67%) of whom received immunotherapy. The use of systemic therapy, including immunotherapy, increased significantly over time. Having Medicaid-only insurance was independently associated with a 45% lower likelihood of receiving any systemic treatment [0.55 (95% CI: 0.35, 0.85)] and a 43% lower likelihood of receipt of immunotherapy [0.57 (95% CI: 0.34, 0.95)] compared with private insurance.
Stage III-IV melanoma patients with Medicaid-only insurance were less likely to receive systemic therapy or immunotherapy than patients with private insurance or Medicare insurance. This finding raises concerns about insurance-based disparities in treatment access.
先前对转移性黑色素瘤住院患者的研究表明，社会人口统计学因素（包括保险类型）可能与接受系统治疗有关。
在北卡罗来纳州的广泛患者队列中，检查保险类型是否与黑色素瘤患者接受系统治疗有关。
我们进行了一项回顾性队列研究，研究对象为 2011 年至 2017 年间北卡罗来纳州中央癌症登记处的数据，这些数据与全州范围内的医疗保险、医疗补助和私人健康保险索赔相联系。主要结局是接受任何系统治疗，次要结局是接受免疫治疗。
共有 372 名患者符合纳入标准。平均年龄为 68 岁（四分位间距：56-76），61%为男性。在队列中，48%的患者仅拥有医疗保险，29%的患者拥有私人保险，12%的患者同时拥有医疗保险和医疗补助，11%的患者仅拥有医疗补助。共有 186 名（50%）患者接受了黑色素瘤的系统治疗，其中 125 名（67%）患者接受了免疫治疗。随着时间的推移，系统治疗（包括免疫治疗）的使用率显著增加。仅拥有医疗补助保险的患者接受任何系统治疗的可能性降低了 45%[0.55（95%置信区间：0.35，0.85）]，接受免疫治疗的可能性降低了 43%[0.57（95%置信区间：0.34，0.95）]，与私人保险相比。
仅拥有医疗补助保险的 III-IV 期黑色素瘤患者接受系统治疗或免疫治疗的可能性低于拥有私人保险或医疗保险的患者。这一发现引发了对治疗机会方面基于保险的差异的关注。
