Advanced Laryngeal Cancer More Likely in Uninsured and Medicaid Patients

ATLANTA, Aug. 20 -- Advanced laryngeal cancer occurs disproportionately among the uninsured and patients on Medicaid, according to investigators here.

Uninsured and Medicaid populations had almost double the risk of advanced-stage disease at diagnosis compared with patients covered by private insurance, reported Amy Y. Chen, M.D., of Emory University, and colleagues, in the August issue of Archives of Otolaryngology-Head and Neck Surgery.

The same two patient populations were three to four times more likely to have large-volume tumors at diagnosis compared with privately insured patients, they added on the basis of a retrospective review of a large database.

"Our analyses provide the first assessment, to our knowledge, of the strong association between medical insurance and stage of laryngeal cancer at diagnosis among a large, generalizable cohort," the authors concluded. "Insurance coverage is a highly modifiable factor that affects not only tumor associated morbidity and mortality but also quality of life and economic costs."

The findings came from a review of laryngeal cancer cases in the National Cancer Database. Since 1999 about three fourths of newly diagnosed cancers in the United States have been included in the database, the authors noted.

The review encompassed all cases of invasive squamous cell carcinoma of the larynx diagnosed from 1996 to 2002. Of 76,529 cases initially identified, about 15,400 were excluded for various reasons, leaving 61,131 cases for analysis. The primary independent variable was the Facility Oncology Registry Data Standards element for payer or insurance status at diagnosis.

Overall, 32,665 (53.4%) of patients had early-stage disease at diagnosis, and 28,466 (46.6%) had advanced disease. Grouping of the cases by T stage showed that 22,693 (37.1%) had T1 disease, 15,111 (24.7%) had T2 disease, 13,541 (22.2%) had T3 disease, and 9,786 (16.0%) had T4 disease.

After controlling for covariates that include sex, age, race, treatment facility, education, and income, the investigators found that uninsured patients had an odds ratio of 1.97 for advanced cancer at diagnosis compared with patients who had private insurance. Medicaid patients had more than twice the risk (OR 2.42) for advanced-stage disease compared with privately insured patients. Separate analyses showed that Medicaid and uninsured patients were more likely to be diagnosed with stage T2, T3, or T4 disease.

Uninsured patients accounted for 4.4% early-stage disease at diagnosis, compared with 8.7% of advanced disease (P