TY - JOUR
T1 - Insurance status and level of education predict disparities in receipt of treatment and survival for anal squamous cell carcinoma
AU - Patel, Krishan S.
AU - Alhatem, Albert
AU - Gadde, Uttara
AU - Ahlawat, Sushil
AU - Lambert, Clark
AU - Schwartz, Robert A.
AU - Dalla Piazza, Michelle
N1 - Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/8
Y1 - 2020/8
N2 - Introduction: Anal squamous cell carcinoma (ASCC) is relatively rare, but its incidence and mortality have been steadily climbing in marginalized populations. We explored the impact of insurance status, education, and income on survival and receipt of chemoradiation therapy. Methods: We included patients with ASCC from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Socioeconomic variables included insurance status, level of education, income, and unemployment rate. Cox proportional hazards and multivariate logistic regression were used to determine predictors of survival and receipt of chemoradiation. Results: We included a total of 10,868 cases of ASCC. The median age was 55, 10.4 % were black, and 65.4 % were female. Overall, 74.1 % of patients received combination chemoradiation. In multivariate analysis, poorer survival was found for Medicaid (HR 1.52, 95 % CI 1.34−1.74) and uninsured (HR 1.68, 95 % CI 1.35−2.10) patients, and for communities with the lowest rates of high school education (HR 1.17, 95 % CI 1.02−1.38), lowest income (HR 1.29, 95 % CI 1.08−1.54), and highest unemployment (HR 1.21, 95 % CI 1.03−1.40). Patients were less likely to receive combination treatment if they were black (OR 0.76, 95 % CI 0.55−0.92), had Medicaid insurance (OR 0.54, 95 % CI 0.33−0.88) or lower education (OR 0.59, 95 % CI 0.46−0.76). Conclusion: Insurance status, level of education, income, and employment impact survival and receipt of treatment in patients with ASCC. Identifying high risk patients and developing targeted interventions to improve access to treatment is integral to reducing these disparities and improving cancer survival.
AB - Introduction: Anal squamous cell carcinoma (ASCC) is relatively rare, but its incidence and mortality have been steadily climbing in marginalized populations. We explored the impact of insurance status, education, and income on survival and receipt of chemoradiation therapy. Methods: We included patients with ASCC from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Socioeconomic variables included insurance status, level of education, income, and unemployment rate. Cox proportional hazards and multivariate logistic regression were used to determine predictors of survival and receipt of chemoradiation. Results: We included a total of 10,868 cases of ASCC. The median age was 55, 10.4 % were black, and 65.4 % were female. Overall, 74.1 % of patients received combination chemoradiation. In multivariate analysis, poorer survival was found for Medicaid (HR 1.52, 95 % CI 1.34−1.74) and uninsured (HR 1.68, 95 % CI 1.35−2.10) patients, and for communities with the lowest rates of high school education (HR 1.17, 95 % CI 1.02−1.38), lowest income (HR 1.29, 95 % CI 1.08−1.54), and highest unemployment (HR 1.21, 95 % CI 1.03−1.40). Patients were less likely to receive combination treatment if they were black (OR 0.76, 95 % CI 0.55−0.92), had Medicaid insurance (OR 0.54, 95 % CI 0.33−0.88) or lower education (OR 0.59, 95 % CI 0.46−0.76). Conclusion: Insurance status, level of education, income, and employment impact survival and receipt of treatment in patients with ASCC. Identifying high risk patients and developing targeted interventions to improve access to treatment is integral to reducing these disparities and improving cancer survival.
KW - Anal cancer
KW - Chemotherapy
KW - Education
KW - Insurance
KW - Radiation therapy
KW - Socioeconomic
KW - Squamous
KW - Survival
KW - Treatment
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U2 - 10.1016/j.canep.2020.101723
DO - 10.1016/j.canep.2020.101723
M3 - Article
C2 - 32408241
AN - SCOPUS:85084374055
SN - 1877-7821
VL - 67
JO - Cancer Epidemiology
JF - Cancer Epidemiology
M1 - 101723
ER -