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J Neurol Surg B Skull Base 2023; 84(03): 240-247
DOI: 10.1055/s-0042-1747962
Original Article

Health Insurance Coverage and Survival Outcomes among Nasopharyngeal Carcinoma Patients: A SEER Retrospective Analysis

Ashley Diaz 
1   Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, United States
,
Daniel Bujnowski 
2   Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, United States
,
Haobin Chen
3   Program in Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, United States
,
Keaton Pendergrast 
4   University of Minnesota Medical School – Twin Cities, Minneapolis, Minnesota, United States
,
Peleg Horowitz
5   Section of Neurosurgery, Department of Surgery, The University of Chicago, Chicago, Illinois, United States
,
Paramita Das
5   Section of Neurosurgery, Department of Surgery, The University of Chicago, Chicago, Illinois, United States
,
Christopher Roxbury
6   Section of Otolaryngology, Department of Surgery, The University of Chicago, Chicago, Illinois, United States
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Abstract

Objectives Insurance coverage plays a critical role in head and neck cancer care. This retrospective study examines how insurance coverage affects nasopharyngeal carcinoma (NPC) survival in the United States using the Surveillance, Epidemiology, and End Results (SEER) program database.

Design, Setting, and Participants A total of 2,278 patients aged 20 to 64 years according to the International Classification of Diseases for Oncology (ICD-O) codes C11.0–C11.9 and ICD-O histology codes 8070–8078 and 8080–8083 between 2007 and 2016 were included and grouped into privately insured, Medicaid, and uninsured groups. Log-rank test and multivariable Cox's proportional hazard model were performed.

Main Outcome Measures Tumor stage, age, sex, race, marital status, disease stage, year of diagnosis, median household county income, and disease-specific survival outcomes including cause of death were analyzed.

Results Across all tumor stages, privately insured patients had a 59.0% lower mortality risk than uninsured patients (hazard ratio [HR]: 0.410, 95% confidence interval [CI]: [0.320, 0.526], p < 0.01). Medicaid patients were also estimated to have 19.0% lower mortality than uninsured patients (HR: 0.810, 95% CI: [0.626, 1.048], p = 0.108). Privately insured patients with regional and distant NPC had significantly better survival outcomes compared with uninsured individuals. Localized tumors did not show any association between survival and type of insurance coverage.

Conclusion Privately insured individuals had significantly better survival outcomes than uninsured or Medicaid patients, a trend that was preserved after accounting for tumor grade, demographic and clinicopathologic factors. These results underscore the difference in survival outcomes when comparing privately insured to Medicaid/uninsured populations and warrant further investigation in efforts for health care reform.

Keywords

insurance status - nasopharyngeal carcinoma - survival outcomes - insurance coverage - health insurance

Note

This work will be presented in a podium presentation at the North American Skull Base Society Annual Meeting in Phoenix, Arizona, United States on February 20, 2022.


Authors' Contribution

All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors conceptualized and designed the study. All authors helped in data acquisition and analysis and interpretation. All authors drafted the manuscript. Critical revision and final approval were done by all authors.




Publication History

Received: 05 December 2021

Accepted: 07 March 2022

Article published online:
02 May 2022

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