denotes an abstract that is clinically relevant.
denotes that this is a recommended PHD Trainee Session.
denotes that this is a ticketed session.Session: ASH Poster Walk on Diversity, Equity and Inclusion(DEI) in Hematology
1Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; 2Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA; 3Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA; 4Department of Health Policy and Management, Emory University Rollins School of Public Health, Decatur, GA; 5Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA; 6The University of Chicago Medical Center, Chicago, IL; 7Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
Methods: We identified 13,655 children and AYAs (ages 0-39 years) newly diagnosed with lymphoma between 2007-2012, using the linked Surveillance, Epidemiology, and End Results (SEER) registries and Medicaid enrollment data. To measure coverage continuity, we categorized patients into those with 1) continuous Medicaid (enrolled in Medicaid for ≥12 months prior to and through diagnosis), 2) newly gained Medicaid (enrolled in the month of or within 12 months after diagnosis), 3) other patterns of noncontinuous Medicaid, 4) private insurance at diagnosis, 5) other insurance types at diagnosis (Medicare, TRICARE, Military, VA, or Indian/Public Health Service), and 6) unknown or no insurance at diagnosis. The last 3 groups comprised patients not linked to Medicaid enrollment data; thus their insurance continuity patterns were unknown, and their insurance status at the time of diagnosis was extracted from SEER registries.
The association between coverage continuity and late-stage diagnosis was examined with separate multivariable logistic regression models among all patients and by cancer subtypes (Hodgkin lymphoma, non-Hodgkin lymphoma). Late-stage was defined as stage IV (vs. stage I-III) using the Ann-Arbor staging classification. Regressions also adjusted for sex, race/ethnicity, age at diagnosis, diagnosis year, rurality, neighborhood socioeconomic status (SES), and state of residence.
Results: Half of our sample had private insurance (50.3%), followed by Medicaid insurance (26.9%), other insurance type (10.3%), and unknown (7.9%) or no insurance (4.7%). Among Medicaid-insured patients, 40.1% had newly gained Medicaid, followed by continuous Medicaid (32.5%) and other patterns of noncontinuous Medicaid (27.3%). Overall, one-fourth (24.8%) of the sample had stage IV lymphoma (Figure 1).
Compared with privately insured patients, the adjusted percentage of stage IV diagnoses was 16.8 percentage points (ppt; 95% CI=14.6-19.0, p<0.001), 10.6 ppt (95% CI=8.2-13.0, p<0.001), and 4.9 ppt (95% CI=2.7-7.1, p<0.001) higher in patients with newly gained Medicaid, other patterns of noncontinuous Medicaid, and continuous Medicaid, respectively. Among the subset of Medicaid-insured patients, the adjusted percentage of stage IV diagnoses was 10.7 ppt (95% CI=7.5-13.8, p<0.001) and 5.4 ppt (95% CI=3.1-7.6, p<0.001) higher among patients with newly gained Medicaid and other patterns of noncontinuous Medicaid, respectively, compared to those with continuous Medicaid. These patterns persisted across lymphoma subtypes.
Notably, coverage continuity patterns varied by sociodemographic factors, with non-Hispanic Black (vs. non-Hispanic White) patients, AYAs ages 15-39 years (vs. pediatric patients ages ≤14), and residents of non-metropolitan (vs. metropolitan) areas or lower SES neighborhoods significantly more likely to have newly gained Medicaid.
Conclusions: Less than one-third of Medicaid-insured children and AYAs with lymphoma had continuous insurance coverage prior to cancer diagnosis. Lacking continuous Medicaid coverage was significantly associated with advanced-stage lymphoma diagnosis.
Disclosures: No relevant conflicts of interest to declare.
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