Lack of Health Insurance Coverage Increases Racial, Ethnic Disparities in Advanced Stage Cancer Diagnoses

A new, large study led by American Cancer Society (ACS) researchers found that lack of health insurance coverage accounts for a significant proportion of racial and ethnic disparities in advanced-stage diagnosis of multiple cancers. The findings are published in the Journal of the National Cancer Institute (JNCI).

“Health insurance coverage is a key determinant of access to high-quality healthcare across the cancer continuum from prevention to early detection, treatment, and survivorship in the United States,” said Dr Parichoy Pal Choudhury, Principal Scientist, Biostatistics at the American Cancer Society and lead author of the study. “These findings could inform appropriate policies geared towards increasing coverage of health insurance for all populations.”

For the study, researchers analyzed data from 1.9 million cancer patients, 18-64 years of age, and diagnosed with one of 10 major cancers between 2013-2019 from the nationwide comprehensive hospital-based National Cancer Database (NCDB). The 10 cancers, which can be detected early through screening, physical examination, or clinical symptoms, included cancers of the breast (female), prostate, colorectum, lung, cervix, head and neck, stomach, urinary bladder, uterus, and skin melanoma.

The study analyses showed evidence of mediation of non-Hispanic Black vs. White disparities in eight cancers (range of proportions mediated: 4.5%-29.1%); Hispanic vs. non-Hispanic White disparities in six cancers (13.2%-68.8%); non-Hispanic Asian/Pacific Islander vs. White disparities in three cancers (5.8%-11.3%). Health insurance accounted for a significant proportion of the racial and ethnic disparities in stage III-IV diagnoses across a wide range of cancers.

“Securing health insurance for everyone is critical,” said Pal Choudhury. “This would result in improved access to healthcare that could lead to a reduction of racial and ethnic disparities in the stage of cancer at the time of diagnosis and consequently racial and ethnic disparities in cancer survival.”

The American Cancer Society Cancer Action Network (ACS CAN) continues to advocate for lawmakers and the courts to protect and strengthen provisions of the Affordable Care Act (ACA), including urging Congress to make permanent the ACA Marketplace enhanced tax credits before they expire at the end of 2025, which have significantly increased health insurance coverage among historically marginalized communities, and urging the Supreme Court to maintain access to no-cost preventive care in the case of Braidwood vs. Becerra.

“This study builds on the extensive amount of evidence showing the importance of health insurance coverage and underscores the need for elected officials to prioritize access to care for everyone,” said Lisa A. Lacasse, president of ACS CAN. “The ACA includes many provisions that have meaningfully improved the health care system and helped reduce barriers to care for cancer patients, survivors, and their families. We urge lawmakers and the courts to preserve and strengthen these critical patient protections so that all people have a fair and just opportunity to prevent, detect, treat, and survive cancer.” Other ACS researchers contributing to the study include Dr Leticia Nogueira, Dr Ahmedin Jemal, and senior author Dr Farhad Islami.