Pal Choudhury Parichoy, Sineshaw Helmneh M, Freedman Rachel A, Halpern Michael T, Nogueira Leticia, Jemal Ahmedin, Islami Farhad
Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA.
Merck & Co, Inc, Rahway, NJ, USA.
J Natl Cancer Inst. 2025 Feb 1;117(2):338-343. doi: 10.1093/jnci/djae242.
For many anatomic cancer sites, it is unclear to what extent differences in health insurance coverage contribute to racial and ethnic disparities in the diagnosis of stage III and IV disease. Using the National Cancer Database (1 893 026 patients aged 18-64 years, diagnosed between 2013 and 2019), we investigated a potential mediating role of health insurance (privately insured vs uninsured) in explaining racial and ethnic disparities in stage at diagnosis of 10 cancers-breast (female), prostate, colorectum, lung, cervix, uterus, stomach, urinary bladder, head and neck, and skin melanoma- detectable early through screening, physical examination, or clinical symptoms. The analyses provided evidence of mediation of disparities among non-Hispanic Black vs White individuals in 8 cancers (range of proportions mediated: 4.5%-29.1%), in Hispanic vs non-Hispanic White individuals in 6 cancers (13.2%-68.8%), and in non-Hispanic Asian or Pacific Islander vs White individuals in 3 cancers (5.8%-11.3%). To summarize, health insurance accounts for a statistically significant proportion of the racial and ethnic disparities in diagnosis of stage III and IV disease across a range of cancer types.
对于许多解剖学上的癌症部位，尚不清楚医疗保险覆盖范围的差异在多大程度上导致了III期和IV期疾病诊断中的种族和民族差异。利用国家癌症数据库（2013年至2019年间诊断的1893026名18 - 64岁患者），我们调查了医疗保险（私人保险与无保险）在解释10种癌症（乳腺癌（女性）、前列腺癌、结直肠癌、肺癌、宫颈癌、子宫癌、胃癌、膀胱癌、头颈癌和皮肤黑色素瘤）诊断阶段的种族和民族差异方面的潜在中介作用，这些癌症可通过筛查、体格检查或临床症状早期检测出来。分析提供了证据，表明在8种癌症中，非西班牙裔黑人与白人个体之间的差异存在中介作用（中介比例范围：4.5% - 29.1%）；在6种癌症中，西班牙裔与非西班牙裔白人个体之间存在中介作用（13.2% - 68.8%）；在3种癌症中，非西班牙裔亚裔或太平洋岛民与白人个体之间存在中介作用（5.8% - 11.3%）。总之，在一系列癌症类型中，医疗保险在III期和IV期疾病诊断的种族和民族差异中占统计学上显著的比例。
