Abstract
Introduction
The impact of health insurance status on the survival outcomes of patients with locally
advanced gastric cancer (LAGC) receiving gastrectomy have not been addressed in depth.
We aim to identify definite associations of health insurance status with cancer-specific
survival (CSS) and overall survival (OS) in this population.
Methods
We identified LAGC patients aged 18 to 64 years undergoing gastrectomy with complete
insurance records, between January 1, 2007, and December 31, 2016, from 18 Surveillance,
Epidemiology, and End Results database registries. Relationships between health insurance
status and OS/CSS were explored by Kaplan-Meier time-to-event analysis and uni-/multi-variate
Cox regression. Probable baseline confounder was adjusted by multiple propensity score
(mPS)-adjusted analysis.
Results
In total, 5,860 patients met the inclusion criteria. In the multivariate Cox regression,
Medicaid coverage was related to poorer OS than private insurance. Non-insurance or
Medicaid coverage versus private insurance tended to present poorer OS in the mPS-adjusted
model, but this result was insignificant for CSS.
Conclusions
Our observational study of exposure-outcome associations suggests that limited or
no insurance is moderately linked with OS among LAGC patients undergoing gastrectomy
and aged 18–64 years. Healthcare accessibility and broad insurance coverage probably
strengthen some disparity outcomes.
Key Indexing Terms
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Article info
Publication history
Published online: April 02, 2022
Accepted:
March 29,
2022
Received:
January 29,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
