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27-05-2021 | Care

Forgoing needed medical care among long-term survivors of childhood cancer: racial/ethnic-insurance disparities

Authors: Jessica L. Baedke, Lauren A. Lindsey, Aimee S. James, I-Chan Huang, Kirsten K. Ness, Carrie R. Howell, Tara M. Brinkman, Nickhill Bhakta, Matthew J. Ehrhardt, Cindy Im, William Letsou, Qi Liu, Leslie L. Robison, Melissa M. Hudson, Yutaka Yasui

Published in: Journal of Cancer Survivorship | Issue 3/2022

Abstract

Purpose

To investigate racial/ethnic-related disparities by insurance status in “forgoing needed medical care in the last year due to finances” in childhood cancer survivors.

Methods

Our study included 3310 non-Hispanic/Latinx White, 562 non-Hispanic/Latinx Black, and 92 Hispanic/Latinx survivors from the St. Jude Lifetime Cohort Study. Logistic regression analyses, guided by Andersen’s Healthcare Utilization Model, were adjusted for “predisposing” (survey age, sex, childhood cancer diagnosis and treatment, and treatment era) and “need” (perceived health status) factors. Additional adjustment for household income/education and chronic health conditions was considered.

Results

Risk of forgoing care was highest among non-Hispanic/Latinx Blacks and lowest among Hispanics/Latinxs for each insurance status. Among privately insured survivors, relative to non-Hispanic/Latinx Whites, non-Hispanic/Latinx Blacks were more likely to forgo care (adjusted OR: 1.82, 95% CI: 1.30–2.54): this disparity remained despite additional adjustment for household income/education (adjusted OR: 1.43, 95% CI: 1.01–2.01). In contrast, publicly insured survivors, regardless of race/ethnicity, had similar risk of forgoing care as privately insured non-Hispanic/Latinx Whites. All uninsured survivors had high risk of forgoing care. Additional chronic health condition adjustment did not alter these results.

Conclusions

Provision of public insurance to all childhood cancer survivors may diminish racial/ethnic disparities in forgoing care that exist among the privately insured and reduce the risk of forgoing care among uninsured survivors to that of privately insured non-Hispanic/Latinx Whites.

Implications for Cancer Survivors

Under public insurance, childhood cancer survivors had low risk of forgoing care, at the similar level to privately insured non-Hispanic/Latinx Whites, regardless of race/ethnicity.

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Title: Forgoing needed medical care among long-term survivors of childhood cancer: racial/ethnic-insurance disparities
Authors: Jessica L. Baedke
Lauren A. Lindsey
Aimee S. James
I-Chan Huang
Kirsten K. Ness
Carrie R. Howell
Tara M. Brinkman
Nickhill Bhakta
Matthew J. Ehrhardt
Cindy Im
William Letsou
Qi Liu
Leslie L. Robison
Melissa M. Hudson
Yutaka Yasui
Publication date: 27-05-2021
Publisher: Springer US
Keyword: Care
Published in: Journal of Cancer Survivorship / Issue 3/2022
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-021-01061-3

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