Insurance Status and Survival of Patients with Salivary Gland Cancer

Abstract

Objectives To evaluate the impact of insurance status on survival among patients with major salivary gland cancer. Study Design Retrospective cohort study. Setting SEER program. Subjects and Methods We included patients aged <65 years diagnosed with major salivary gland cancers from 2007 to 2013. Those aged ≥65 years were excluded due to issues ascertaining insurance status. The independent variable was insurance status (insured, uninsured, or Medicaid); the primary outcome measure was overall survival (OS); and the secondary outcome measure was disease-specific survival (DSS). Results Compared with insured patients, uninsured and Medicaid patients were more likely to present with stage III-IV disease (uninsured: odds ratio [OR], 1.57; 95% CI, 1.09-2.27; Medicaid: OR, 1.67; 95% CI, 1.27-2.20) and with distant metastasis (uninsured: OR, 2.10; 95% CI, 1.18-3.57; Medicaid: OR, 1.96; 95% CI, 1.25-3.01) after adjusting for demographic and tumor variables. Uninsured and Medicaid patients also had worse OS (uninsured: hazard ratio [HR], 1.62; 95% CI, 1.14-2.29; Medicaid: HR, 1.74; 95% CI, 1.33-2.38) and DSS (uninsured: HR, 1.57; 95% CI, 1.08-2.29; Medicaid: HR, 1.68; 95% CI, 1.25-2.25) after adjusting for demographic and tumor variables. After further adjusting for treatment variables, only Medicaid status was significantly associated with worse OS (HR, 1.71; 95% CI, 1.30-2.26) and DSS (HR, 1.65; 95% CI, 1.23-2.23). Conclusions Insurance status is associated with stage at presentation and survival among patients with salivary gland cancer.