Disparities in survival by insurance status in follicular lymphoma

Jordan S. Goldstein, Loretta J. Nastoupil, Xuesong Han, Ahmedin Jemal, Elizabeth Ward and Christopher R. Flowers

Key points

  • Privately-insured patients have improved overall survival among follicular lymphoma patients of all ages.

  • Expanding access to care through insurance has the potential to improve follicular lymphoma outcomes.


INTRODUCTION: Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma and most common indolent non-Hodgkin lymphoma. Lower socioeconomic status is associated with poor outcomes in FL, suggesting access to care is an important prognostic factor; however, the association between insurance status and FL survival has not been sufficiently examined. METHODS: The National Cancer Database (NCDB), a nationwide cancer registry, was used to evaluate 43,648 patients with FL diagnosed between 2004 and 2014. All analyses were performed on two cohorts segmented at age 65 years, to account for changes in insurance status with Medicare eligibility. Cox proportional hazard models calculated hazard ratios (HRs) with confidence intervals (CI) for the association between insurance status and overall survival (OS) controlling for the available sociodemographic and prognostic factors and Kaplan-Meier curves display outcomes by insurance status for patients covered by: private insurance, no insurance, Medicaid, and Medicare. RESULTS: When compared to patients under age 65 with private insurance, patients under 65 with no insurance (HR 1.96 [95% CI 1.69,2.28]), Medicaid (1.82 [1.57, 2.12]), and Medicare (1.96 [1.71,2.24]) had significantly worse OS, after adjusting for sociodemographic and prognostic factors. Compared to patients age 65 and over with private insurance, those with Medicare (1.28 [1.17,1.4]) only had significantly worse OS. CONCLUSION: For adults with FL, expanding access to care through insurance has the potential to improve outcomes.

  • Submitted March 12, 2018.
  • Accepted July 6, 2018.