Health Insurance Type at Diagnosis Impacts Disparities in Cancer Survival Among Adolescents and Young Adults

FREMONT, CA (July 10, 2017) — Cancer is the most frequent cause of disease-related death among adolescents and young adults (AYAs) between 15–39 years of age.

In this new study led by the Cancer Prevention Institute of California and published in the July 10, 2017 issue of Cancer Causes Control, researchers examined joint associations between sociodemographic factors — race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance — and cancer survival for the most frequent cancers among AYAs.

While cancer survival among AYAs with many types of cancer is above 80 percent, they have not experienced the same improvements in survival and have a higher uninsured rate in comparison to children and older adults. 

Researchers found public or no insurance was associated with greater risk of death for 11 of 12 cancers examined. The six cancer sites with the highest relative survival rates (thyroid, testis, melanoma, breast, Hodgkin’s lymphoma, and non-Hodgkin lymphoma) showed the strongest associations between no or public insurance and shorter survival, which suggests that insurance influences long-term care and survivorship in addition to the initial diagnosis and treatment period.

However, researchers also found disparities in cancer survival by race/ethnicity and nSES were more pronounced among AYAs with private/military insurance compared to public or no insurance. Specifically, greater risk of death was identified among Hispanic and Asian AYAs, compared to White AYAs, for younger AYAs and for those with private/military insurance. .  

To explain these results, researchers point to recent studies that found greater financial burden associated with a cancer diagnosis for those that are relatively young, of non-White race/ethnicity, or have lower SES, regardless of insurance status. 

Furthermore, differences in receiving or completing treatment, cancer subtype, or neighborhood built and social factors (e.g., walkability, proximity to medical facilities, education and social support) by race/ethnicity or nSES may help explain this finding.  

According to Mindy C. DeRouen, PhD, MPH, the lead researcher on this study, “The study’s novel finding of prominent sociodemographic disparities among AYAs with private/military insurance suggests that increasing private insurance coverage alone will not alleviate, and may actually exacerbate, sociodemographic disparities in cancer survival. Future studies should determine whether financial burden or other social factors contribute to undertreatment or reduced follow-up care, even among the privately insured.” 

To conduct this population-based study, data were obtained from the California Cancer Registry on 80,855 AYAs diagnosed with invasive cancer between 2001-2011. 

Additional study co-authors are Helen M. Parsons of the University of Texas, Erin E. Kent of the National Cancer Institute, and Brad H. Pollock and Theresa H. M. Keegan of UC Davis.

This work was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885 and the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute at the National Institutes of Health under contract 0000140C awarded to the Cancer Prevention Institute of California. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN2612010000140C awarded to the Cancer Prevention Institute of California.

About the Cancer Prevention Institute of California
The Cancer Prevention Institute of California is a nonprofit organization dedicated to preventing cancer and to reducing its burden where it cannot yet be prevented. We are the only freestanding research institution working solely to prevent cancer using extensive population data. Our researchers study a wide range of cancer risk factors, such as racial/ethnic background, socioeconomic status, age, occupation, gender, genetic predisposition, geographic location, environment and lifestyle to determine how these factors affect frequency, distribution and types of cancers. For more information, visit the CPIC website at www.cpic.org. 

Media Contact: 
Donna Lock, 510-608-5160 | donna.lock@cpic.org



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