Abstract LB247: Effects of health insurance on survival for five common cancers in China: A multicenter, hospital-based, retrospective cohort study
Authors: Ling Ni, Mengyuan Xu, Xianhui Ran, Hongmei Zeng
Journal: Cancer Research (2025)

Abstract Background: Health insurance may influence cancer patients' access to care and health outcomes. However, the effect of health insurance on survival for cancer patients in China is not well known. We aimed to assess the association between health insurance and survival for five common cancers in China using a national cancer database. Methods: This study used a retrospective, multicenter, hospital-based longitudinal cohort design. We included 23 hospitals in 12 provinces across China, representing different socioeconomic statuses. We identified patients diagnosed with cancers of the lung, stomach, colorectum, esophagus, and female breast between January 1, 2016, and December 31, 2017, with follow-up until December 31, 2023. We categorized health insurance into the New Rural Cooperative Medical Insurance Scheme (NRCMS), urban insurance (including urban resident-based basic medical insurance and urban employment-based basic medical insurance), and other types. We used multivariable Cox models to assess the effect of health insurance on survival and quantify the mediation effects of potential factors in the association between health insurance and cancer survival. Results: We included 51,647 patients, among whom 48.6% (25,121) had urban insurance, 22.8% (11,779) had NRCMS, and 28.6% (14,747) had other types. We found that NRCMS patients had higher all-cause mortality (adjusted hazard ratios [HR] 1.42, 95% CI 1.38-1.46) than patients with urban insurance. By stage at diagnosis, NRCMS patients showed higher HRs of all-cause mortality across each stage compared with those with urban insurance. This finding was most prominent for patients diagnosed at early stages (stage I: HR 1.61, 95% CI 1.4-1.86; stage II: HR 1.32, 95% CI 1.21-1.45; stage III: HR 1.29, 95% CI 1.22-1.37; stage IV: HR 1.13, 95% CI 1.07-1.19). By specific cancer type, we found the greatest magnitudes in the association between health insurance type and survival for breast cancer (HR 1.76, 95% CI 1.53-2.02) and lung cancer (HR 1.72, 95% CI 1.64-1.80). The stage at diagnosis, hospital level, and cancer-directed surgery status explained 40%, 19%, and 17% of survival disparities between patients with NRCMS and those with urban insurance. Conclusions: Survival disparities exist across cancer patients by health insurance status in China, especially for those diagnosed at early stages. Bridging healthcare utilization gaps among cancer patients with different insurance coverage is crucial for improving outcomes. Citation Format: Ling Ni, Mengyuan Xu, Xianhui Ran, Hongmei Zeng. Effects of health insurance on survival for five common cancers in China: A multicenter, hospital-based, retrospective cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_2):Abstract nr LB247.