Study links insurance status to prostate Ca disease severity

Insurance status is strongly associated with disease severity among prostate cancer patients, researchers from the American Cancer Society recently reported.

The study, which was published in Cancer Epidemiology Biomarkers and Prevention (2010; 19:2437-44), finds that men who were uninsured or Medicaid-insured at the time of diagnosis had significantly higher PSA levels, clinical T stage, and Gleason scores than men with private insurance. Greater disease severity among men who are uninsured or Medicaid-insured likely reflects lower access to medical care and utilization of PSA testing and a higher proportion of non screen-detected cancers, the study authors say.

The researchers, led by epidemiologist Stacey A. Fedewa, MPH, analyzed data from 312,339 prostate cancer patients diagnosed between 2004 and 2006 in the National Cancer Database. The study found uninsured and Medicaid-insured patients’ PSA levels were approximately 4.0 ng/mL higher than those of privately insured patients after adjusting for age, race, comorbidity, and area level socioeconomic status.

Men who were uninsured or Medicaid-insured were also more likely to have the highest Gleason score (OR=1.97 95% CI: 1.82-2.12 and OR=1.67 95% CI: 1.55-1.79, respectively). Finally, the uninsured and Medicaid-insured were more likely to be diagnosed with advanced disease (OR=1.85, 95% CI: 1.69-2.03 and OR=1.49, 95% CI: 1.35-1.63, respectively).

"Strong associations between insurance and disease severity are likely to be related to lack of access to preventive services such as PSA screening and barriers to timely medical evaluation of urologic symptoms," the authors wrote. "Although there are unresolved questions about risks and benefits of PSA screening, it is important that all men have the opportunity to be informed about this option as well as access to other preventative health services and primary care."