Impact of Health Insurance and Sociodemographic Status on Survival for AYAs With Cancer

Key Points

  • Public or no health insurance was associated with a greater risk of death from 11 of 12 common cancers found in adolescents and young adults (AYAs).
  • Compared with whites, blacks experienced a greater risk of death, regardless of age or insurance status, whereas a greater risk of death among Hispanics and Asians was more apparent for younger AYAs and for those with private/military insurance. 
  • Although health insurance coverage is linked with survival, remaining racial/ethnic and socioeconomic disparities among AYAs with cancer suggest additional social factors also need consideration in intervention and policy development.

According to the National Cancer Institute, cancer is the leading cause of disease-related death among adolescents and young adults (AYAs) between the ages of 15 and 39. And although cancer survival among this age group is more than 80%, AYAs have not experienced the same improvements in relative survival as children and older adults for cancers common among AYAs, perhaps due in part to unique genetic and biologic features of the cancers in young adults.

Other factors may also be contributing to the lower survival rate of AYAs. A study investigating the associations of sociodemographic factors and health insurance status with survival for AYAs with invasive cancer has found that public or no health insurance was associated with a greater risk of death from 11 of 12 cancers examined in the study. In addition, disparities in cancer survival by race/ethnicity and neighborhood sociodemographic status were more pronounced among AYAs with private/military insurance than those with public or no health insurance, especially among younger AYAs. The study by DeRouen et al was published in Cancer Causes & Control.

Study Methodology

The researchers analyzed data obtained from the California Cancer Registry on 80,855 AYAs with invasive cancer diagnosed in California between 2001 and 2011. The data contained information on race/ethnicity, age at diagnosis, marital status, year of diagnosis, sex, and stage of disease. The researchers used multivariable Cox proportional hazards regression to estimate overall survival. The most common types of cancers examined included breast (14.5%), thyroid (12.7%), melanoma (9.8%), testicular (9.1%), non-Hodgkin lymphoma (5.8%), Hodgkin lymphoma (5.8%), leukemia (5.3%), cervical (5.2%), sarcoma (5.2%), colorectal (4.9%), central nervous system (4.1%), and ovarian (2.3%).

Study Findings

The researchers found public or no health insurance was associated with a greater risk of death from 11 of the 12 cancers examined. The six cancer sites with the highest relative survival rates, including thyroid, testis, melanoma, breast, Hodgkin lymphoma, and non-Hodgkin lymphoma, showed the strongest associations between no or public health insurance and shorter survival, suggesting health insurance influences long-term care and survivorship in addition to the initial diagnosis and treatment period.

Compared with whites, blacks experienced a greater risk of death, regardless of age or insurance status, whereas a greater risk of death among Hispanics and Asians was more apparent for younger AYAs and for those with private or military insurance. More pronounced neighborhood sociodemographic status disparities in survival were observed among AYAs with private/military insurance, especially among younger AYAs.

Contributing Factors to Survival Disparities

“Lacking or having public insurance was consistently associated with shorter survival, while disparities according to race/ethnicity and neighborhood [sociodemographic status] were greater among AYAs with private/military insurance. While health insurance coverage associates with survival, remaining racial/ethnic and socioeconomic disparities among AYAs with cancer suggest additional social factors also need consideration in intervention and policy development,” concluded the study authors.

Mindy C. DeRouen, PhD, MPH, staff scientist at the Cancer Prevention Institute of California and lead author of this study, said in a statement, “The study’s novel finding of prominent sociodemographic disparities among AYAs with private/military insurance suggests that increasing private insurance coverage alone will not alleviate, and may actually exacerbate, sociodemographic disparities in cancer survival. Future studies should determine whether financial burden or other social factors contribute to undertreatment or reduced follow-up care, even among the privately insured.”

Funding for this study was provided by the California Department of Public Health and the National Cancer Institute. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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