Does Health Insurance Status Affect Childhood Cancer Survival

Faculty; Public Health; Research

Privately insured children and those with Medicaid at the time of a cancer diagnosis experience largely similar survival trends, with slight evidence for an increased risk of cancer death in children who were uninsured at diagnosis, finds a new study from the Brown School at Washington University in St. Louis.

“Our findings support the idea that Medicaid is comparable to private insurance for kids with cancer, meaning that, in this setting at least, it is not inferior. This contributes to policy discussion on Medicaid expansion by providing evidence that public outlays on Medicaid are well spent,” said Kimberly Johnson, associate professor at the Brown School and co-author of the study, “The Effect of Health Insurance on Childhood Cancer Survival in the United States,” published Sept. 11 in CANCER, a peer-reviewed journal of the American Cancer Society.

An estimated 10,380 U.S. children younger than 15 years of age are diagnosed with cancer each year, and, although survival rates have increased, differences have been reported based on cancer type and race/ethnicity. However, the association between health insurance status and childhood cancer survival has not been well-studied.

To further investigate the issue, Johnson and her co-authors, including Rohit Ojha of JPS Health Network in Fort Worth, Texas, examined information from the Surveillance, Epidemiology, and End Results (SEER) cancer registry, which publishes cancer incidence and survival data from population-based cancer registries covering approximately 28 percent of the U.S. population.

The team specifically looked at data on cancers diagnosed among children aged younger than 15 from 2007-09.

Among 8,219 individuals with childhood cancer (131 without insurance, 2,838 with Medicaid, and 4,297 with private insurance) who were followed for five years, average survival was 1.32 months shorter for uninsured children and 0.62 months shorter for children with Medicaid, when compared to those with private insurance.

Children who were uninsured had a 26-percent higher risk of cancer death than those who were privately insured at diagnosis, whereas the risk for those with Medicaid was similar to those with private insurance at diagnosis.

The findings suggest that cancer survival is largely similar between children with Medicaid and those with private insurance at diagnosis; however, slightly inferior survival was observed for those who were uninsured. This latter result is based on a small number of uninsured children, and should be interpreted cautiously.