UMass Chan Medical School Faculty Publications


Does increasing insurance improve outcomes for US cancer patients

UMMS Affiliation

Surgical Outcomes Analysis and Research, Department of Surgery

Publication Date


Document Type



Adult; Female; Humans; Incidence; Insurance, Health; Male; Medically Uninsured; Neoplasm Staging; Neoplasms; *Outcome Assessment (Health Care); Proportional Hazards Models; SEER Program; United States


Health and Medical Administration | Health Services Administration | Health Services Research | Insurance | Neoplasms | Surgery


BACKGROUND: Although debate continues on US healthcare and insurance reform, data are lacking on the effect of insurance on community-level cancer outcomes. Therefore, the objective of the present study was to examine the association of insurance and cancer outcomes.

MATERIALS AND METHODS: The US Census Bureau Current Population Survey, Small Area Health Insurance Estimates (2000) were used for the rates of uninsurance. Counties were divided into tertiles according to the uninsurance rates. The data were compared with the cancer incidence and survival for patients residing in counties captured by the Surveillance, Epidemiology, and End Results database (2000-2006). Aggregate patient data were collected of US adults (aged >/=18 y) diagnosed with the following cancers: pancreatic, esophageal, liver or bile duct, lung or bronchial, ovarian, colorectal, breast, prostate, melanoma, and thyroid. The outcomes included the stage at diagnosis, surgery, and survival. Univariate tests and proportional hazards were calculated.

RESULTS: The US uninsurance rate was 14.2%, and the range for the Surveillance, Epidemiology, and End Results counties was 8.3%-24.1%. Overall, patients from lower uninsurance rate counties demonstrated longer median survival. Adjusting for patient characteristics and cancer stage (for each cancer), the patients in the higher uninsurance rate counties demonstrated greater mortality (8%-15% increased risk on proportional hazards). The county uninsurance rate was associated with the stage at diagnosis for all cancers, except pancreatic and esophageal, and was also associated with the likelihood of being recommended for cancer-directed surgery (for all cancers).

CONCLUSIONS: Health insurance coverage at a community level appears to influence survival for patients with cancer. Additional investigations are needed to examine whether individual versus community associations exist and how best to surmount barriers to cancer care.

DOI of Published Version



Smith JK, Ng SC, Zhou Z, Carroll JE, McDade TP, Shah SA, Tseng JF. Does increasing insurance improve outcomes for US cancer patients? J Surg Res. 2013 Nov;185(1):15-20. doi:10.1016/j.jss.2013.05.058. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

The Journal of surgical research

PubMed ID