Abstract B128: The effect of insurance status on age of prostate cancer mortality
Authors: Sadiq Zuhair , Rana Shahryar , Memon Abdullah , Memon Ramiz , Park Henry 
Published: January 2023

Abstract
Background: Prostate cancer is one of the leading causes of cancer death among men [1]. Therefore, it is imperative that patients have adequate access to timley oncologic care [2]. However, access to timely diagnosis and care for prostate cancer patients may be affected by insurance status [3]. Here we investigate if insurance status is associated with worse mortality for prostate cancer patients. Methods: This study utilizes the National Longitudinal Mortality Study (NLMS) database, which includes 745,162 records of patients who were interviewed in April 2002 and followed up for 6 years in the United States [4]. We extracted all records of men for whom “malignant neoplasms of the prostate” was indicated as the cause of mortality. This search yielded 1434 records of men who died within the six years following their interview. 726 of these patients did not have a record of their insurance status. We stratified the remaining 708 patients by insurance type and compared their ages at death. The different insurance types included Medicare (79.3%), Medicaid (0.4%), non-Medicare non-Medicaid government healthcare (1.8%), employer (14.7%), and private coverage (3.7%). We performed an unpaired t-test to compare the age at death of the patients with and without health insurance in the calendar year prior to the interview. We also calculated the Hedges’ g to estimate the effect size [5]. Statistical significance in the mean age of mortality among insured patients was assessed with ANOVA followed by Tukey-Kramer's multiple comparison test [6].Results: The mean age of mortality for prostate cancer patients without insurance is 66.03 years, which is significantly lower than the mean age of 71.63 years for prostate cancer patients who have insurance (p&lt;0.0003). The effect-size estimates suggest that having insurance of any kind results in decreased mortality significantly. The differences in ages of mortality between insurance types were significant (p&lt;0.001) with patients with Medicare having the highest mean age of mortality of 74.66 years compared to other four groups that were included in the study. The rest of the groups that were compared using the intergroup analysis in the study did not have a significant difference in mortality age among them with exception of the comparison between employer-based coverage and private coverage with private coverage having significantly higher mean mortality age of 65.44 (p&lt;0.0001).Conclusion: Insured patients with prostate cancer had longer life expectancy than prostate cancer patients without insurance. This leads to the hypothesis that patients with financial limitations may have worse outcomes relating to prostate cancer diagnosis, treatment and mortality [7]. Further research is needed to evaluate why Medicare-insured have significantly higher mean age of mortality when compared to other groups of insurance types.
Citation Format: Zuhair Sadiq, Shahryar Rana, Abdullah Memon, Ramiz Memon, Henry Park. The effect of insurance status on age of prostate cancer mortality [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B128.