Abstract 2143: Association between health insurance coverage and stage of diagnosis for cervical cancer among women in Indiana from 2011-2019
Authors: Babu Mrithula Suresh , Kasting Monica L. , Rodriguez Natalia M. 
Published: March 2024

Abstract
Introduction: Cervical cancer is one of the most common types of cancer among women and it is caused by infection from the human papillomavirus (HPV). The incidence rates of cervical cancer have increased in Indiana from 7.8 in 2008-2012 to 8.4 in 2013-2017. In 2020, the screening rate for cervical cancer among women in Indiana was 76% when compared to a national average of 78%. Women diagnosed at earlier stages for cervical cancer had higher relative survival of 0.98 than those diagnosed at later stages with a relative survival of 0.43. Health insurance status is an important determinant for health outcomes for patients with cancer. This study aims to assess the extent to which health insurance coverage is a contributing factor to the stage of cervical cancer diagnosis.
Methods: We examined reported cases of cervical cancer among women (N=2518) using cervical cancer registry data from the Indiana State Department of Health from 2011-2019. Using multinomial logistic regression model, we examined the associations of both race/ethnicity and insurance status with stage of diagnosis after adjusting for age at diagnosis.
Results: In this sample, the average age at diagnosis was 48.98 years (SD = 14.98). The largest proportion of the sample was between 45 to 64 years of age (41.7%), Non-Hispanic White (85.5%), had private insurance coverage (41.8%), had cervix uteri, NOS as the primary site of diagnosis (76.5%), lived in a metropolitan area (74.5%) and had squamous cell carcinoma (73.4%). The largest percentage of Non-Hispanic White patients had private insurance (50.9%), whereas the largest percentage of Black patients had Medicaid (39.3%). 20.2% of Hispanic patients were uninsured when compared to 7.7% Non-Hispanic White and 3.6% Black patients. The multivariate analysis shows that women who are uninsured (OR = 2.475) and those who have Medicaid (OR = 2.321) were significantly more likely to be diagnosed at the regional stage than the in-situ stage compared to women with private insurance. Additionally, women who are uninsured (OR = 4.432) and those who have Medicaid (OR = 3.007) were significantly more likely to be diagnosed at the distant stage than in-situ, compared to women with private insurance.
Conclusion: The findings show that insurance status is associated with the stage of diagnosis for cervical cancer and detection at regional or distant stages often leads to higher morbidity. Impact - Increased coverage for routine cervical cancer screening and preventive care services is recommended, especially for uninsured women and women with public insurance such as Medicaid or Medicare.
Citation Format: Mrithula Suresh Babu, Monica L. Kasting, Natalia M. Rodriguez. Association between health insurance coverage and stage of diagnosis for cervical cancer among women in Indiana from 2011-2019 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2143.