Abstract 5861: Insurance and survival among lung cancer patients: Comparison of the US military health system and the surveillance, epidemiology, and end results (SEER) program
Authors: Lin Jie , Shriver Craig , Zhu Kangmin 
Published: June 2022

Abstract
Accessibility to medical care is related health insurance. The U.S. military health system (MHS) provides beneficiaries with universal health care. Our previous studies showed improved survival of the MHS patients with lung cancer compared to those in the US general population covered by the Surveillance, Epidemiology, and End Results (SEER) program. This study expanded the previous studies by further comparing MHS patient with SEER patients with different insurances to provide evidence on the effects of insurance status on survival. The MHS patients were identified from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). The SEER patients were identified from the 18 cancer registries of the SEER program. All patients were diagnosed with histologically confirmed lung cancer between 2007 and 2013. The SEER program defines insurance type as insured (private insurance, Medicare administered through a managed care plan or private supplement), insured/no specifics (Medicare NOS, insurance NOS), any Medicaid (Indian/Public health Service, Medicaid, Medicaid administered through a managed care plan, Medicare with Medicaid eligibility), and uninsured (no insurance, self-pay). The results showed that compared to ACTUR, SEER patients with non-small cell lung cancer exhibited increased risk of mortality regardless of their insurance type. Specifically, the adjusted HR (95% CI) was 1.08 (1.03-1.13), 1.22 (1.16-1.28), 1.40 (1.33-1.47), 1.49 (1.41-1.58), for SEER insured, insured/no specifics, Medicaid, and uninsured, respectively. This pattern was consistently observed in subgroups by age, gender, race, and tumor stage. Among small-cell lung cancer patients, the higher HR compared to ACTUR was significant only for Medicaid (HR=1.24, 95% CI=1.11-1.38) and uninsured (HR=1.28, 95% CI=1.13-1.45). Furthermore, compared to ACTUR, the likelihood of receiving surgery was significantly lower in SEER with odds ratios (95% CIs) of 0.85 (0.76-0.95), 0.64 (0.57-0.72), 0.40 (0.36-0.45), and 0.34 (0.29-0.39) for insured, insurance/no specifics, Medicaid, and uninsured, respectively, and was observed regardless of tumor stage. Our study suggests that the MHS lung cancer patients had survival advantage over the SEER patients and the advantage was even larger when compared to Medicaid or uninsured patients. In addition, the SEER patients were less likely to receive surgery regardless of tumor stage, especially for Medicaid or uninsured patients. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions, or policies of the USUHS, HJF, the DoD or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.
Citation Format: Jie Lin, Craig Shriver, Kangmin Zhu. Insurance and survival among lung cancer patients: Comparison of the US military health system and the surveillance, epidemiology, and end results (SEER) program [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5861.