Abstract PO-202: Cancer survival differences among Medicare beneficiaries and their younger uninsured counterparts

Purpose: To assess cancer survival differences between uninsured patients younger than age 65 years with their immediate older counterparts age 66-69 years with Medicare coverage. Methods: Data from the National Cancer Data Base were used for this study. The main outcomes were 1-, 2-, and 5-year survival for 16 cancer types in 1,206,821 newly diagnosed patients. We characterized patients by insurance and age categories and used Kaplan-Meier method with log-rank test for statistical significance to calculate all-cause 1-, 2-, and 5-year survival rates. The analysis assessed differences between uninsured and insured patients age 60-64 years with those aged 66-69 years with Medicare coverage. Cox proportional hazards models were used to generate hazard ratios (HR) of all-cause mortality. Results: Uninsured patients aged 60-64 years had higher proportion with late stage disease, and lower proportion with receipt of surgery, chemotherapy or radiotherapy than Medicare beneficiaries aged 66-69 years. Younger uninsured patients had significantly worse 1-, 2-, and 5-year survival overall and by race/ethnicity, comorbidity score, and cancer type compared with their older counterparts with Medicare coverage. In a stratified analysis by cancer type, uninsured younger patients had strikingly lower 1-, 2- and 5- year survival for nearly all 16 cancers compared with older Medicare patients. For instance, the 1-year and 2-year survival differences between younger uninsured and older Medicare +/- private insured patients showed the largest differences of about 20% for patients with lung cancer (adjusted HR (aHR) = 1.42; 95% CI, 1.38-1.47; and aHR = 1.37; 95% CI, 1.33-1.41; respectively). Similarly, 5-year survival rates in uninsured younger patients with colorectal and breast cancer were 8-15% lower compared with older Medicare patients (aHR = 1.34; 95% CI, 1.27-1.41 and aHR = 1.56; 95% CI, 1.44-1.69; respectively). Conclusions: Survival after a diagnosis of cancer is considerably lower in uninsured younger patients age 60-64 years than in older Medicare patients age 66-69 years. Our findings suggest that expanding uniform health insurance coverage to individuals approaching Medicare eligibility age down to the age of 60 could substantially improve cancer survival in the United States. Citation Format: Helmneh M. Sineshaw, K. Robin Yabroff, Ahmedin Jemal, Gerard A. Silvestri. Cancer survival differences among Medicare beneficiaries and their younger uninsured counterparts [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-202.