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Insurance status as a modifier of the association between race and stage of prostate cancer diagnosis in Florida during 1995 and 2013
Affiliation:1. Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, United States;2. Department of Urology, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, United States;1. Centre for Big Data Research in Health, University of New South Wales Sydney, NSW, Australia;2. Centre for Primary Health Care and Equity, University of New South Wales Sydney, NSW, Australia;3. School of Medicine, University of Wollongong, NSW, Australia;4. National Drug and Alcohol Research Centre, University of New South Wales Sydney, NSW, Australia;5. Faculty of Medicine and Health, University of Sydney, NSW, Australia;6. Cancer Voices NSW, NSW, Australia;1. MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC;2. Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC;3. Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC;4. Georgetown University Medical Center, Washington, DC;5. MedStar Health Research Institute, Washington, DC;6. Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC;7. Department of Surgery, University of Miami, Miami, FL;1. Department of Dermatology, University of Southern California, Los Angeles, California;2. Spatial Sciences Institute and Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California;3. Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California;1. Department of Urology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA;2. Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA;3. Department of Urology, VA NY Harbor Healthcare System, 800 Poly Place, Brooklyn, NY 11209, USA;4. Department of Radiation Oncology, VA NY Harbor Healthcare System, 800 Poly Place, Brooklyn, NY 11209, USA;1. Division of Gynecologic Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC;2. Division of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC;3. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
Abstract:BackgroundCancer stage at diagnosis is a critical prognostic factor regarding a patient’s health outcomes. It has yet to be shown whether insurance status across different race has any implications on the stage of disease at the time of diagnosis. This study aimed to investigate whether insurance status was a modifier of the association between race and stage of previously undetected prostate cancer at the time of diagnosis in Florida between 1995 and 2013.MethodsSecondary data analysis of a cross-sectional survey using information from the Florida Cancer Data System (n = 224,819). Study participants included black and white males diagnosed with prostate cancer in Florida between 1995 and 2013. The main outcome variable was stage of prostate cancer at diagnosis. The main independent variable was race (black vs white). Adjusted logistic regression models were used to explore the association between race, insurance status and stage at diagnosis. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated.ResultsBlack males were more likely to be diagnosed with late stage prostate cancer (OR 1.31; 95% CI 1.27–1.35). Being uninsured (OR 2.28; 95% CI 2.13–2.45) or having Medicaid (OR 1.84; 95% CI 1.70–1.98) was associated with a diagnosis of late stage cancer. Stratified analysis for health insurance revealed that blacks had an increased risk for late stage cancer if uninsured (OR 1.29; 95% CI 1.07–1.55) and if having Medicare (OR 1.39; 95% CI 1.31–1.48).Conclusion: Insurance status may modify the effect of race on late stage prostate cancer in black patients.
Keywords:Health disparity  Race  Prostate cancer  Screening  Late-stage diagnosis  Florida  Insurance
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