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Survival disparities among non-elderly American adults with locally advanced gastric cancer undergoing gastrectomy by health insurance status

      Abstract

      Introduction

      The impact of health insurance status on the survival outcomes of patients with locally advanced gastric cancer (LAGC) receiving gastrectomy have not been addressed in depth. We aim to identify definite associations of health insurance status with cancer-specific survival (CSS) and overall survival (OS) in this population.

      Methods

      We identified LAGC patients aged 18 to 64 years undergoing gastrectomy with complete insurance records, between January 1, 2007, and December 31, 2016, from 18 Surveillance, Epidemiology, and End Results database registries. Relationships between health insurance status and OS/CSS were explored by Kaplan-Meier time-to-event analysis and uni-/multi-variate Cox regression. Probable baseline confounder was adjusted by multiple propensity score (mPS)-adjusted analysis.

      Results

      In total, 5,860 patients met the inclusion criteria. In the multivariate Cox regression, Medicaid coverage was related to poorer OS than private insurance. Non-insurance or Medicaid coverage versus private insurance tended to present poorer OS in the mPS-adjusted model, but this result was insignificant for CSS.

      Conclusions

      Our observational study of exposure-outcome associations suggests that limited or no insurance is moderately linked with OS among LAGC patients undergoing gastrectomy and aged 18–64 years. Healthcare accessibility and broad insurance coverage probably strengthen some disparity outcomes.

      Key Indexing Terms

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