PMID- 36889628
OWN - NLM
STAT- MEDLINE
DCOM- 20230620
LR  - 20230624
IS  - 1097-6833 (Electronic)
IS  - 0022-3476 (Linking)
VI  - 257
DP  - 2023 Jun
TI  - Health Insurance Coverage and Racial/Ethnic Disparities in US Childhood and 
      Adolescent Cancer Survival.
PG  - 113378
LID - S0022-3476(23)00137-3 [pii]
LID - 10.1016/j.jpeds.2023.02.022 [doi]
AB  - OBJECTIVE: To evaluate potential effect modification by health insurance coverage 
      on racial and ethnic disparities in cancer survival among US children and 
      adolescents. STUDY DESIGN: Data from 54 558 individuals diagnosed with cancer at 
      </= 19 years between 2004 and 2010 were obtained from the National Cancer Database. 
      Cox proportional hazards regression was used for analyses. An interaction term 
      between race/ethnicity and health insurance type was included to examine 
      racial/ethnic disparities in survival by each insurance status category. RESULTS: 
      Racial/ethnic minorities experienced a 14%-42% higher hazard of death compared 
      with non-Hispanic Whites (NHWs) with magnitudes varying by health insurance type 
      (P(interaction) < .001). Specifically, among those reported as privately insured, 
      the hazard of death was higher for non-Hispanic Blacks (NHBs) (hazard ratio 
      [HR] = 1.48, 95% CI: 1.36-1.62), non-Hispanic American Indian/Alaskan Natives 
      (HR = 1.99, 95% CI: 1.36-2.90), non-Hispanic Asians or Pacific Islanders 
      (HR = 1.30, 95% CI: 1.13-1.50), and Hispanics (HR = 1.28, 95% CI: 1.17-1.40) vs 
      NHWs. Racial/ethnic disparities in survival among those reported as covered by 
      Medicaid were present for NHBs (HR = 1.30, 95% CI: 1.19-1.43) but no other 
      racial/ethnic minorities (HR ranges: 0.98 approximately 1.00) vs NHWs. In the uninsured group, 
      the hazard of death for NHBs (HR = 1.68, 95% CI: 1.26-2.23) and Hispanics 
      (HR = 1.27, 95% CI: 1.01-1.61) was higher vs NHWs. CONCLUSIONS: Disparities in 
      survival exist across insurance types, particularly for NHB childhood and 
      adolescent cancer patients vs NHWs with private insurance. These findings provide 
      insights for research and policy, and point to the need for more efforts on 
      promoting health equity while improving health insurance coverage.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Wang, Xiaoyan
AU  - Wang X
AD  - Brown School, Washington University in St. Louis, St. Louis, MO.
FAU - Brown, Derek S
AU  - Brown DS
AD  - Brown School, Washington University in St. Louis, St. Louis, MO.
FAU - Cao, Yin
AU  - Cao Y
AD  - Division of Public Health Sciences, Department of Surgery, Washington University 
      School of Medicine, St. Louis, MO; Alvin J. Siteman Cancer Center, Washington 
      University School of Medicine, St. Louis, MO.
FAU - Ekenga, Christine C
AU  - Ekenga CC
AD  - Rollins School of Public Health, Emory University, Atlanta, GA.
FAU - Guo, Shenyang
AU  - Guo S
AD  - Brown School, Washington University in St. Louis, St. Louis, MO.
FAU - Johnson, Kimberly J
AU  - Johnson KJ
AD  - Brown School, Washington University in St. Louis, St. Louis, MO; Alvin J. Siteman 
      Cancer Center, Washington University School of Medicine, St. Louis, MO. 
      Electronic address: kijohnson@wustl.edu.
LA  - eng
PT  - Journal Article
DEP - 20230306
PL  - United States
TA  - J Pediatr
JT  - The Journal of pediatrics
JID - 0375410
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Humans
MH  - *Ethnicity
MH  - *Healthcare Disparities
MH  - Hispanic or Latino
MH  - Insurance Coverage
MH  - Insurance, Health
MH  - *Neoplasms
MH  - United States/epidemiology
MH  - White
MH  - Black or African American
MH  - American Indian or Alaska Native
OTO - NOTNLM
OT  - adolescent
OT  - health care disparities
OT  - neoplasm
OT  - pediatric
OT  - survival
EDAT- 2023/03/09 06:00
MHDA- 2023/06/20 06:42
CRDT- 2023/03/08 19:34
PHST- 2022/10/18 00:00 [received]
PHST- 2023/02/06 00:00 [revised]
PHST- 2023/02/20 00:00 [accepted]
PHST- 2023/06/20 06:42 [medline]
PHST- 2023/03/09 06:00 [pubmed]
PHST- 2023/03/08 19:34 [entrez]
AID - S0022-3476(23)00137-3 [pii]
AID - 10.1016/j.jpeds.2023.02.022 [doi]
PST - ppublish
SO  - J Pediatr. 2023 Jun;257:113378. doi: 10.1016/j.jpeds.2023.02.022. Epub 2023 Mar 
      6.