Abstract
Purpose
The U.S. military health system (MHS) provides beneficiaries with universal health care while health care access varies in the U.S. general population by insurance status/type. We divided the patients from the U.S. general population by insurance status/type and compared them to the MHS patients in survival.
Methods
The MHS patients were identified from the Department of Defense’s Automated Central Tumor Registry (ACTUR). Patients from the U.S. general population were identified from the Surveillance, Epidemiology, and End Results (SEER) program. Multivariable Cox regression analysis was conducted to compare different insurance status/type in SEER to ACTUR in overall survival.
Results
Compared to ACTUR patients with non-small cell lung cancer (NSCLC), SEER patients showed significant worse survival. The adjusted hazard ratios (HRs) were 1.08 [95% Confidence Interval (CI) = 1.03–1.13], 1.22 (95% CI = 1.16–1.28), 1.40 (95% CI = 1.33–1.47), 1.50 (95% CI = 1.41–1.59), for insured, insured/no specifics, Medicaid, and uninsured patients, respectively. The pattern was consistently observed in subgroup analysis by race, gender, age, or tumor stage. Results were similar for small cell lung cancer (SCLC), although they were only borderline significant in some subgroups.
Conclusion
The survival advantage of patients receiving care from a universal health care system over the patients from the general population was not restricted to uninsured or Medicaid as expected, but was present cross all insurance types, including patients with private insurance. Our findings highlight the survival benefits of universal health care system to lung cancer patients.
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Data availability
ACTUR data are not available for public use according to DoD regulations.
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Acknowledgements
The authors thank Joint Pathology Center (formerly Armed Forces Institute of Pathology) for providing ACTUR data and the National Cancer Institute for the use of the SEER data.
Funding
This project was supported by Murtha Cancer Center Research Program via Uniformed Services University of the Health Sciences under the auspices of the Henry. M. Jackson Foundation for the Advancement of Military medicine.
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Conceptualization: JL, CDS, KZ, Methodology: JL, KZ, Formal analysis and investigation: JL, KZ, Writing—original draft: JL, Writing-review and editing: JL, CDS, KZ, Funding acquisition: CDS, Resources: CDS, KZ.
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Lin, J., Shriver, C.D. & Zhu, K. Survival among lung cancer patients: comparison of the U.S. military health system and the surveillance, epidemiology, and end results (SEER) program by health insurance status. Cancer Causes Control 35, 21–31 (2024). https://doi.org/10.1007/s10552-023-01765-0
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DOI: https://doi.org/10.1007/s10552-023-01765-0