Commentary: Health insurance and children ’s survival after cancer diagnosis: mediation or confounding?

Improvements in diagnosis and treatment of paediatric cancer have achieved dramatic increases in expected survival.1 However, such medical advances risk exacerbating health inequalities along lines of class or socio-economic status (SES).2 Arguably, patients of high SES benefit from earlier diagnosis and earlier or more definitive treatment, resulting in improved clinical outcomes.2 Using health insurance type (private insurance compared with need-based public Medicaid insurance) as the measure of SES, Wanget al. demonstrate this disparity when considering 5-year all-cause mortality among children and adolescents diagnosed with cancer in the USA.3 Among a sample of 58  421 patients aged 0–19 years from the National Cancer Database (NCDB), 65% were covered by private insurance and 28% were covered by Medicaid insurance, with the latter increasing the hazard of all-cause mortality by a factor of 1.27 (95% confidence interval, 1.22–1.33). Children with unknow n coverage (3%) and no coverage (4%) also had increased hazard of all-cause mortality, relative to children with private insurance.
Source: International Journal of Epidemiology - Category: Epidemiology Source Type: research