Uninsured Patients With DLBCL Have Inferior Overall Survival

Lack of insurance was an independent risk factor for inferior overall survival in a study of US adults diagnosed with diffuse large B‐cell lymphoma (DLBCL) between 2004 and 2017, according to an abstract presented at the 2021 ASCO Annual Meeting.

“Our data highlight the independent effect of insurance disparities — a potential indicator of variations in access to health care — on survival in DLBCL,” wrote a team from the Mayo Clinic’s hematology division in Rochester, Minnesota.

Researchers used the National Cancer Database to identify 93,692 adults younger than 65 who were newly diagnosed with DLBCL between 2004 and 2017. Among them, 69.1% had private insurance, 12.7% had Medicaid, 10.5% had Medicare, and 7.7% were uninsured.

Compared with patients covered by private insurance, Medicaid, or Medicare, patients who were uninsured were more likely to have a median annual household outcome of less than $38,000, less likely to receive chemotherapy, and more likely to be male, nonWhite, and present with stage III or IV disease, according to the abstract.

After adjustment for baseline comorbidity, advanced stage, treatment with chemotherapy, and a slate of sociodemographic factors, patients who were uninsured had inferior overall survival, researchers reported. Over a median follow-up of 14.8 years, median overall survival was 13.4 years for uninsured patients compared with 14.8 years for insured patients.

“Despite the lack of major changes in DLBCL therapies,” the authors wrote, “a diagnosis after the implementation of the Affordable Care Act (in 2010 or later) was associated with a superior overall survival when compared with the outcomes of patients diagnosed in 2010 or earlier.”

Reference:
Saliba AN, Andrade-Gonzalez X, Hampel PJ, et al. Insurance status and survival in diffuse large B-cell lymphoma: A National Cancer Database study before and after the Affordable Care Act. Abstract presented at 2021 ASCO Annual Meeting; June 4-8, 2021.