Skip to main content
SpringerLink
Log in

Sociodemographic disparities in survival for adolescents and young adults with cancer differ by health insurance status

  • Original paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Purpose

To investigate associations of sociodemographic factors—race/ethnicity, neighborhood socioeconomic status (SES), and health insurance—with survival for adolescents and young adults (AYAs) with invasive cancer.

Methods

Data on 80,855 AYAs with invasive cancer diagnosed in California 2001–2011 were obtained from the California Cancer Registry. We used multivariable Cox proportional hazards regression to estimate overall survival.

Results

Associations of public or no insurance with greater risk of death were observed for 11 of 12 AYA cancers examined. Compared to Whites, Blacks experienced greater risk of death, regardless of age or insurance, while greater risk of death among Hispanics and Asians was more apparent for younger AYAs and for those with private/military insurance. More pronounced neighborhood SES disparities in survival were observed among AYAs with private/military insurance, especially among younger AYAs.

Conclusions

Lacking or having public insurance was consistently associated with shorter survival, while disparities according to race/ethnicity and neighborhood SES were greater among AYAs with private/military insurance. While health insurance coverage associates with survival, remaining racial/ethnic and socioeconomic disparities among AYAs with cancer suggest additional social factors also need consideration in intervention and policy development.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bleyer A, Budd T, Montello M (2006) Adolescents and young adults with cancer: the scope of the problem and criticality of clinical trials. Cancer 107:1645–1655

    Article  PubMed  Google Scholar 

  2. Bleyer A, Choi M, Fuller CD, Thomas CR Jr, Wang SJ (2009) Relative lack of conditional survival improvement in young adults with cancer. Semin Oncol 36:460–467

    Article  PubMed  Google Scholar 

  3. Keegan THRL, Barr RD, Geiger AM, Dahlke DV, Pollock BH, Bleyer WA (2016) National cancer institute next steps for adolescent and young adult ONCOLOGY epidemiology working group. Comparison of cancer survival trends in the United States of adolescents and young adults with those in children and older adults. Cancer 122(7):1009–1016

    Article  PubMed  Google Scholar 

  4. Bleyer A, Ulrich C, Martin S (2012) Young adults, cancer, health insurance, socioeconomic status, and the Patient Protection and Affordable Care Act. Cancer 118:6018–6021

    Article  PubMed  Google Scholar 

  5. Keegan TH, Tao L, DeRouen MC et al (2014) Medical care in adolescents and young adult cancer survivors: what are the biggest access-related barriers? J Cancer Surviv 8:282–292

    Article  PubMed  PubMed Central  Google Scholar 

  6. Parsons HM, Schmidt S, Harlan LC et al (2014) Young and uninsured: insurance patterns of recently diagnosed adolescent and young adult cancer survivors in the AYA HOPE study. Cancer 120:2352–2360

    Article  PubMed  PubMed Central  Google Scholar 

  7. Derouen MC, Gomez SL, Press DJ, Tao L, Kurian AW, Keegan TH (2013) A population-based observational study of first-course treatment and survival for adolescent and young adult females with breast cancer. J Adolesc Young Adult Oncol 2:95–103

    Article  PubMed  PubMed Central  Google Scholar 

  8. Keegan TH, Grogan RH, Parsons HM et al (2015) Sociodemographic disparities in differentiated thyroid cancer survival among adolescents and young adults in California. Thyroid 25:635–648

    Article  PubMed  PubMed Central  Google Scholar 

  9. Keegan TH, Press DJ, Tao L et al (2013) Impact of breast cancer subtypes on 3-year survival among adolescent and young adult women. Breast Cancer Res 15:R95

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kent EE, Morris RA, Largent JA, Ziogas A, Sender LS, Anton-Culver H (2010) Socioeconomic impacts on survival differ by race/ethnicity among adolescents and young adults with non-Hodgkin’s lymphoma. J Cancer Epidemiol 2010:824691

    PubMed  PubMed Central  Google Scholar 

  11. Aizer AA, Falit B, Mendu ML et al (2014) Cancer-specific outcomes among young adults without health insurance. J Clin Oncol 32:2025–2030

    Article  PubMed  PubMed Central  Google Scholar 

  12. Robbins AS, Lerro CC, Barr RD (2014) Insurance status and distant-stage disease at diagnosis among adolescent and young adult patients with cancer aged 15 to 39 years: National Cancer Data Base, 2004 through 2010. Cancer 120:1212–1219

    Article  PubMed  Google Scholar 

  13. Rosenberg AR, Kroon L, Chen L, Li CI, Jones B (2015) Insurance status and risk of cancer mortality among adolescents and young adults. Cancer 121:1279–1286

    Article  PubMed  Google Scholar 

  14. Keegan TH, DeRouen MC, Parsons HM et al (2016) Impact of treatment and insurance on socioeconomic disparities in survival after adolescent and young adult Hodgkin lymphoma: a population-based study. Cancer Epidemiol Biomark Prev 25:264–273

    Article  Google Scholar 

  15. Bleyer A, Barr R, Hayes-Lattin B, Thomas D, Ellis C, Anderson B (2008) The distinctive biology of cancer in adolescents and young adults. Nat Rev Cancer 8:288–298

    Article  CAS  PubMed  Google Scholar 

  16. Section CS. (1997) Cancer Reporting in California: Standards for Automated Reporting. California Cancer Reporting System Standards, Volume II. Sacramento, California, USA: Cancer Surveillance Section, California Department of Health Services

  17. Section CS. (1997) Abstract and Coding Procedures for Hospitals. California Cancer Reporting System Standards, Volume I. Sacramento, California, USA: Cancer Surveillance Section, California Department of Health Services

  18. Section CS. (1997) Reporting Procedures for Physicians. California Cancer Reporting System Standards, Volume IV. Sacramento, California, USA: Cancer Surveillance Section, California Department of Health Services

  19. Sections CS. (1997) Cancer Reporting in California: Data Standard for Regional Registries and California Cancer Registry. California Cancer Reporting System Stadards, Volume III. Sacramento, California, USA: Cancer Surveillance Section, California Department of Health Services

  20. Barr RD, Holowaty EJ, Birch JM (2006) Classification schemes for tumors diagnosed in adolescents and young adults. Cancer 106:1425–1430

    Article  PubMed  Google Scholar 

  21. Gomez SL, Glaser SL (2006) Misclassification of race/ethnicity in a population-based cancer registry (United States). Cancer Causes Control 17:771–781

    Article  PubMed  Google Scholar 

  22. Yost K, Perkins C, Cohen R, Morris C, Wright W (2001) Socioeconomic status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control 12:703–711

    Article  CAS  PubMed  Google Scholar 

  23. Yang JSC, Harrati A, Clarke C, Keegan THM, Gomez SL (2014) Developing an area-based socioeconomic measure from American Community Survey data. Cancer Prevention Institute of California, Fremont

    Google Scholar 

  24. Smith EC, Ziogas A, Anton-Culver H (2013) Delay in surgical treatment and survival after breast cancer diagnosis in young women by race/ethnicity. JAMA Surg 148:516–523

    Article  PubMed  Google Scholar 

  25. Martin S, Ulrich C, Munsell M, Taylor S, Lange G, Bleyer A (2007) Delays in cancer diagnosis in underinsured young adults and older adolescents. Oncologist 12:816–824

    Article  PubMed  Google Scholar 

  26. Kleinbaum DG, Klein M (2005) Chapter 5: the stratified cox procedure survival analysis: a self-learning text, Second Edition edn. Springer, New York, pp 173–210

    Google Scholar 

  27. Butow P, Palmer S, Pai A, Goodenough B, Luckett T, King M (2010) Review of adherence-related issues in adolescents and young adults with cancer. J Clin Oncol 28:4800–4809

    Article  PubMed  Google Scholar 

  28. Polite BN, Griggs JJ, Moy B et al (2014) American Society of Clinical Oncology policy statement on medicaid reform. J Clin Oncol 32:4162–4167

    Article  PubMed  PubMed Central  Google Scholar 

  29. DeRouen MC, Smith AW, Tao L et al (2015) Cancer-related information needs and cancer’s impact on control over life influence health-related quality of life among adolescents and young adults with cancer. Psychooncology 24:1104–1115

    Article  PubMed  PubMed Central  Google Scholar 

  30. Howlader N, Noone A, Kraphco M et al (2012) SEER cancer statistics review, 1975-2009 (vintage 2009 populations). National Cancer Institute, Bethesda

    Google Scholar 

  31. Charles S (2015) Adult medi-cal enrollment surges, uninsured rate plummets in 2014. UCLA Center for Health Policy Research, Los Angeles

    Google Scholar 

  32. Ward E, Halpern M, Schrag N et al (2008) Association of insurance with cancer care utilization and outcomes. Cancer J Clin 58:9–31

    Article  Google Scholar 

  33. Lillie-Blanton M, Hoffman C (2005) The role of health insurance coverage in reducing racial/ethnic disparities in health care. Health Aff (Millwood) 24:398–408

    Article  Google Scholar 

  34. Gorey KM, Luginaah IN, Holowaty EJ, Zou G, Hamm C, Balagurusamy MK (2013) Mediation of the effects of living in extremely poor neighborhoods by health insurance: breast cancer care and survival in California, 1996 to 2011. Int J Equity Health 12:6

    Article  PubMed  PubMed Central  Google Scholar 

  35. Banegas MP, Guy GP Jr, de Moor JS et al (2016) For working-age cancer survivors, medical debt and bankruptcy create financial hardships. Health Aff (Millwood) 35:54–61

    Article  Google Scholar 

  36. Khera N (2014) Reporting and grading financial toxicity. J Clin Oncol 32:3337–3338

    Article  PubMed  Google Scholar 

  37. Moriates C, Shah NT, Arora VM (2013) First, do no (financial) harm. JAMA 310:577–578

    Article  CAS  PubMed  Google Scholar 

  38. Shankaran V, Jolly S, Blough D, Ramsey SD (2012) Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol 30:1608–1614

    Article  PubMed  Google Scholar 

  39. Ubel PA, Abernethy AP, Zafar SY (2013) Full disclosure–out-of-pocket costs as side effects. N Engl J Med 369:1484–1486

    Article  CAS  PubMed  Google Scholar 

  40. Yabroff KR, Dowling EC, Guy GP et al (2015) Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol 34(3):259–267

    Article  PubMed  PubMed Central  Google Scholar 

  41. Zafar SY, Abernethy AP (2013) Financial toxicity, part I: a new name for a growing problem. Oncology (Williston Park) 27(80–1):149

    Google Scholar 

  42. Zafar SY, Peppercorn JM, Schrag D et al (2013) The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 18:381–390

    Article  PubMed  PubMed Central  Google Scholar 

  43. Neugut AI, Subar M, Wilde ET et al (2011) Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol 29:2534–2542

    Article  PubMed  PubMed Central  Google Scholar 

  44. Freedman RA, Virgo KS, He Y et al (2011) The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer 117:180–189

    Article  PubMed  Google Scholar 

  45. Wu XC, Lund MJ, Kimmick GG et al (2012) Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol 30:142–150

    Article  PubMed  Google Scholar 

  46. American Society of Clinical O (2016) The State of Cancer Care in America, 2016: a report by the american society of clinical oncology. J Oncol Pract 12:339–383

    Article  Google Scholar 

  47. Keegan TH, Lichtensztajn DY, Kato I et al (2012) Unmet adolescent and young adult cancer survivors information and service needs: a population-based cancer registry study. J Cancer Surviv 6:239–250

    Article  PubMed  PubMed Central  Google Scholar 

  48. Keegan TH, DeRouen MC, Press DJ, Kurian AW, Clarke CA (2012) Occurrence of breast cancer subtypes in adolescent and young adult women. Breast Cancer Res 14:R55

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Jacobs EA, Rathouz PJ, Karavolos K et al (2014) Perceived discrimination is associated with reduced breast and cervical cancer screening: the Study of Women’s Health Across the Nation (SWAN). J Womens Health (Larchmt). 23:138–145

    Article  PubMed Central  Google Scholar 

  50. Benjamins MR, Whitman S (2014) Relationships between discrimination in health care and health care outcomes among four race/ethnic groups. J Behav Med 37:402–413

    Article  PubMed  Google Scholar 

  51. Parker LJ, Hunte H, Ohmit A (2015) Discrimination in health care: correlates of health care discrimination among black males. Am J Mens Health

  52. Krieger N (1999) Embodying inequality: a review of concepts, measures, and methods for studying health consequences of discrimination. Int J Health Serv 29:295–352

    Article  CAS  PubMed  Google Scholar 

  53. Krieger N, Davey Smith G (2004) Bodies count, and body counts: social epidemiology and embodying inequality. Epidemiol Rev 26:92–103

    Article  PubMed  Google Scholar 

  54. Chae DH, Nuru-Jeter AM, Adler NE et al (2014) Discrimination, racial bias, and telomere length in African-American men. Am J Prev Med 46:103–111

    Article  PubMed  PubMed Central  Google Scholar 

  55. Tehranifar P, Neugut AI, Phelan JC et al (2009) Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiol Biomark Prev 18:2701–2708

    Google Scholar 

  56. Gomez SL, Shariff-Marco S, DeRouen M et al (2015) The impact of neighborhood social and built environment factors across the cancer continuum: current research, methodological considerations, and future directions. Cancer 121:2314–2330

    Article  PubMed  PubMed Central  Google Scholar 

  57. Clegg LX, Reichman ME, Hankey BF et al (2007) Quality of race, Hispanic ethnicity, and immigrant status in population-based cancer registry data: implications for health disparity studies. Cancer Causes Control 18:177–187

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885 and the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute at the National Institutes of Health under contract HHSN2612010000140C awarded to the Cancer Prevention Institute of California (to MCD), a National Cancer Institute Career Development Award (Grant Number K07CA175063 to HMP), and a Cancer Center Support Grant-P30 from the National Institutes of Health (Grant Number CA093373 to BHP). EEK did not receive financial support for this project. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN2612010000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #1U58 DP000807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors and endorsement by the State of California, Department of Health Services, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.

Author information

Authors and Affiliations

  1. Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA

    Mindy C. DeRouen

  2. Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Helen M. Parsons

  3. Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20850, USA

    Erin E. Kent

  4. Department of Public Health Sciences, University of California, One Shields Avenue, Med Sci 1-C, Davis, CA, 95616, USA

    Brad H. Pollock

  5. Division of Hematology and Oncology, UC Davis Comprehensive Cancer Center, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA

    Theresa H. M. Keegan

Authors
  1. Mindy C. DeRouen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helen M. Parsons
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erin E. Kent
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brad H. Pollock
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Theresa H. M. Keegan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mindy C. DeRouen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

DeRouen, M.C., Parsons, H.M., Kent, E.E. et al. Sociodemographic disparities in survival for adolescents and young adults with cancer differ by health insurance status. Cancer Causes Control 28, 841–851 (2017). https://doi.org/10.1007/s10552-017-0914-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-017-0914-y

Keywords

Search

Navigation