The impact of health insurance coverage on racial/ethnic disparities in US childhood and adolescent cancer stage at diagnosis
Menée à l'aide de données des registres américains des cancers portant sur les enfants et les adolescents ayant reçu un diagnostic de cancer entre 2007 et 2016, cette étude analyse les disparités ethniques dans le stade au diagnostic, en fonction de leur couverture maladie
Background: Racial/ethnic minority children and adolescents are more likely to have an advanced cancer diagnosis compared with non-Hispanic Whites, which may relate to the lack of consistent health care access. This study aims to describe racial/ethnic disparities in cancer diagnosis stage among children and adolescents and assess whether health insurance mediates these disparities. Methods: Data on individuals ≤19 years of age diagnosed with primary cancers from 2007 to 2016 were obtained from the Surveillance, Epidemiology, and End Results 18 database. Prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between race/ethnicity and cancer diagnosis stage were calculated using Poisson regression. Analyses addressing health insurance as a potential mediator were also performed. Results: Compared with non-Hispanic Whites, racial/ethnic minorities had a higher prevalence of a distant cancer diagnosis, with PRs of 1.31 (95% CI, 1.23–1.40) for non-Hispanic Blacks, 1.14 (95% CI, 1.04–1.24) for non-Hispanic Asian/Pacific Islanders, and 1.15 (95% CI, 1.09–1.21) for Hispanics. These associations were attenuated when adjusting for health insurance, with PRs of 1.24 (95% CI, 1.16–1.33) for non-Hispanic Blacks, 1.11 (95% CI, 1.02–1.21) for non-Hispanic Asian/Pacific Islanders, and 1.07 (95% CI, 1.01–1.13) for Hispanics. Any Medicaid or no insurance at diagnosis mediated 49%, 22%, and 9% of the observed association with distant stage in Hispanics, non-Hispanic Blacks, and non-Hispanic Asian/Pacific Islanders, respectively. Conclusions: Disparities in cancer diagnosis stage in racial/ethnic minority children and adolescents may be partially explained by health insurance coverage. Further research is needed to understand the mechanisms.