Insurance status mediates racial, ethnic inequities in advanced cervical cancer

March 15, 2023

2 minutes of reading


Holt reported no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Key takeaways:

  • White women and those with private insurance are more likely to have early-stage cervical cancer at diagnosis.
  • Lack of health insurance accounts for 50% of the racial/ethnic disparity in advanced cervical cancer.

Insurance status substantially mediates racial and ethnic inequality among women with advanced cervical cancer, the investigators report The Open JAMA Network.

“Previous studies have found that cervical cancer outcomes, including stage of diagnosis and survival, are related to insurance status,” Hunter K. Holt, MD, MAS, assistant professor in the department of family and community medicine at the University of Illinois at Chicago, and co-author. “However, this study did not evaluate insurance status as a mediator for more advanced cervical cancer stage at diagnosis between different racial and ethnic groups.”

Proportion of disparity in cervical cancer staging at diagnosis attributable to lack of health insurance (vs. white women):

Data are from Holt HK, et al. The Open JAMA Network. 2023;doi:10.1001/jamanetworkopen.2023.2985.

This retrospective, cross-sectional, population-based study included 23,942 women aged 21 to 64 years (mean age, 45 years) who received a diagnosis of cervical cancer between 2007 and 2016. Using data from Surveillance, Epidemiology, and Outcome (SEER) ) program, researchers identified these women to assess the extent to which racial and ethnic differences in advanced cervical cancer could be affected by insurance status.

In the cohort, 12.9% of the women were black, 24.5% were Hispanic or Latina and 52.9% were white; 59.4% have private insurance or Medicare.

The researchers observed lower proportions of women being American Indian or Native Alaskans (48.7%), Asian or Pacific Islander (49.9%), Black (41.7%) and Hispanic or Latino (51.6%). with a diagnosis of early-stage cervical cancer compared to white women (53.3%). Compared with women who were uninsured or had Medicaid coverage, the majority of women with private insurance or Medicare had a diagnosis of early-stage cervical cancer (41.1% vs 57.8%).

When adjusted for age, year of diagnosis, histological type, region-level socioeconomic status and insurance status, black women had a higher likelihood of being diagnosed with advanced cervical cancer compared to white women (OR = 1.18; 95% CI, 1 .08-1.29) .

In addition, lack of health insurance or having Medicaid insurance contributed to racial and ethnic inequality in the diagnosis of cervical cancer across all racial and ethnic minority groups, by 51.3% for black women, 52.5% for American Indian or Alaska Native women, 53.8% for Asian or Pacific Islander women and 55.1% for Hispanic or Latina women compared to white women.

“While our findings suggest that most cancer inequality is associated with insurance status, we also recognize that equity in insurance coverage will not unilaterally eliminate cervical cancer,” the researchers wrote.

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