Impact of Insurance on Overall Survival in Acute Lymphoblastic Leukemia: A SEER Database Study

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 22; no. 7; pp. e477 - e484
• Main Authors: Joshi, Utsav, Khanal, Shital, Bhetuwal, Uttam, Bhattarai, Adheesh, Dhakal, Prajwal, Bhatt, Vijaya Raj
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2022
• Subjects: Age; ALL; Health care disparity; Sociodemographic factors; Survival outcome; ALL; Survival outcome; Sociodemographic factors; Age; Health care disparity
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2022.01.001

Insurance status at diagnosis remains an important barrier to health care access and adherence to treatment. Here, we aim to assess the impact of insurance status, and age on overall survival (OS) in patients with acute lymphoblastic leukemia (ALL).
Using the Surveillance, Epidemiology, and End Results database, we identified all patients younger than 65 years of age diagnosed with ALL from 2010 to 2016. OS was estimated for each group using the Kaplan Meier curves and compared based on insurance type using a log-rank test. Multivariate analysis using Cox proportional hazard regression model was used to assess the effect of insurance status on OS.
A total of 9057 patients were included in the analysis. Medicaid beneficiaries had worse 5-year OS than insured patients (HR 1.33, 95% CI 1.08-1.63, P = .006) in 0-18 years age group. Despite chemotherapy, patients older than 18 years showed poor OS in all insurance categories. Patients on Medicaid showed inferior OS compared to insured in 19-40 years (HR 1.46, 95% CI 1.21-1.76, P < .001) and 41-65 years age group (HR 1.27, 95% CI 1.09-1.49, P = .003). Interestingly, no significant difference was observed in the OS between the Medicaid and uninsured groups in each age category.
Our large database study demonstrates that insured status is associated with better OS in ALL across all age groups. Further studies to develop effective strategies to bridge health care disparities areessential.
Insurance status at diagnosis is a barrier to access and adherence to treatment in acute lymphoblastic leukemia (ALL). Using the SEER database, we analyzed data of 9057 patients younger than 65 years, and diagnosed with ALL from 2010 to 2016. Insured patients across all age categories had better overall survival compared to Medicaid or uninsured patients.