Expansion of health insurance and prostate cancer outcomes

An article originally published in Prostate Cancer and Prostatic Diseases, earlier this year, predicts that expansion of insurance coverage here in the USA will have major impact on prostate cancer outcomes in the relatively near future.

The full text of this article by Mahal et al. is now available on the Medscape web site (or you can just see the abstract here). And whether one does or does not approve of the way in which insurance coverage has recently been expanded (i.e., the Patient Protection and Affordable Care Act), the findings of this study seem to be really very clear when it comes to prostate cancer:

expanding insurance coverage may lead to detection of cancer at a non-metastatic stage, higher rates of appropriate definitive treatment for aggressive high-risk disease and benefits with regard to cancer-specific and all-cause mortality. The results presented here provide evidence in favor of a concerted effort to continue to extend insurance coverage to the uninsured with a goal of reducing the burden of disease caused by aggressive cancers.

Now this is all a politically sensitive topic, and we don’t wish to be seen to “take sides” in what is a complex debate. For what it is worth, however, Mahal et al. show, using data on men of < 65 years of age from the SEER database (i.e., by excluding the vast majority of men who are eligible for and so have insurance through Medicare), that:

  • Compared to uninsured men, insured men were nearly five times less likely to present with metastatic disease (adjusted odds ratio = 0.23; P < 0.001).
  • Compared to uninsured men with high-risk disease, insured men with high-risk disease
    • Were more than twice as likely to receive definitive treatment (adjusted odds ratio = 2.29; P < 0.001)
    • Had a much lower probability of prostate cancer-specific mortality (adjusted hazard ratio = 0.56; P = 0.04)
    • Had a significantly lower probability of all-cause mortality (adjusted hazard ratio = 0.60; P = 0.01)
  • Uninsured patients were more likely to be non-white, to come from regions of rural residence, to have lower median household income, and to have lower education level.

Regardless of one’s views on Obamacare, if the goal is to stop men dying from prostate cancer, expanding health insurance coverage to include those who have historically been un- or under-insured would seem likely to have such impact. Exactly how to expand such coverage is rather more complex!

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