TY - JOUR
T1 - Insurance status as a predictor of mortality in patients undergoing head and neck cancer surgery
AU - Rohlfing, Matthew L.
AU - Mays, Ashley C.
AU - Isom, Scott
AU - Waltonen, Joshua D.
N1 - Publisher Copyright:
© 2017 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2017/12
Y1 - 2017/12
N2 - Objective: Explore relationship between insurance status and survival, determine outcomes that vary based on insurance status, and identify potential areas of intervention. Study Design: Retrospective cohort analysis of patients who underwent resection of an upper aerodigestive tract malignancy at a single tertiary care hospital during a 5-year period. Methods: Patients were categorized into four groups by insurance status: Medicaid or uninsured, Medicare and under 65 years of age, Medicare and 65 years or older, and private insurance. Data were collected from the medical record and analyzed with respect to survival and other outcomes. Results: The final cohort consisted of 860 patients. Survival analysis demonstrated a hazard ratio of 2.1 (95% confidence interval [CI], 1.5–3.0) for the Medicaid/uninsured group when compared to the private insurance group. When adjusted for other variables, mortality was still different across insurance groups (P = 0.002). The following also were different across insurance groups: tumor stage (P < 0.001), American Society of Anesthesiologists score (P < 0.001), length of stay (P < 0.001), and complications (P = 0.021). The Medicaid/uninsured group was most likely to have a complication (odds ratio [OR] = 2.10, 95% CI 1.24–3.56, P = 0.006). Conclusion: Medicaid/uninsured patients present with more advanced tumors and have poorer survival than privately insured patients. Insurance status is predictive of tumor stage, comorbidity burden, length of stay, and complications. Specifically, the Medicaid/uninsured group had high rates of tobacco use and alcohol abuse, advanced stage tumors, and postoperative complications. Because alcohol abuse and advanced stage also were predictors of poor survival, they may contribute to the survival disparity for socially disadvantaged patients. Level of Evidence: 4. Laryngoscope, 127:2784–2789, 2017.
AB - Objective: Explore relationship between insurance status and survival, determine outcomes that vary based on insurance status, and identify potential areas of intervention. Study Design: Retrospective cohort analysis of patients who underwent resection of an upper aerodigestive tract malignancy at a single tertiary care hospital during a 5-year period. Methods: Patients were categorized into four groups by insurance status: Medicaid or uninsured, Medicare and under 65 years of age, Medicare and 65 years or older, and private insurance. Data were collected from the medical record and analyzed with respect to survival and other outcomes. Results: The final cohort consisted of 860 patients. Survival analysis demonstrated a hazard ratio of 2.1 (95% confidence interval [CI], 1.5–3.0) for the Medicaid/uninsured group when compared to the private insurance group. When adjusted for other variables, mortality was still different across insurance groups (P = 0.002). The following also were different across insurance groups: tumor stage (P < 0.001), American Society of Anesthesiologists score (P < 0.001), length of stay (P < 0.001), and complications (P = 0.021). The Medicaid/uninsured group was most likely to have a complication (odds ratio [OR] = 2.10, 95% CI 1.24–3.56, P = 0.006). Conclusion: Medicaid/uninsured patients present with more advanced tumors and have poorer survival than privately insured patients. Insurance status is predictive of tumor stage, comorbidity burden, length of stay, and complications. Specifically, the Medicaid/uninsured group had high rates of tobacco use and alcohol abuse, advanced stage tumors, and postoperative complications. Because alcohol abuse and advanced stage also were predictors of poor survival, they may contribute to the survival disparity for socially disadvantaged patients. Level of Evidence: 4. Laryngoscope, 127:2784–2789, 2017.
KW - Head and neck cancer
KW - head and neck reconstruction
KW - insurance type
KW - social determinants of health
KW - socioeconomic status
KW - surgical outcomes
UR - http://www.scopus.com/inward/record.url?scp=85021214648&partnerID=8YFLogxK
U2 - 10.1002/lary.26713
DO - 10.1002/lary.26713
M3 - Article
C2 - 28639701
AN - SCOPUS:85021214648
SN - 0023-852X
VL - 127
SP - 2784
EP - 2789
JO - Laryngoscope
JF - Laryngoscope
IS - 12
ER -