Healthcare Insurance is Not Linked with Better Outcomes in Hispanic Patients with Lymphoma

Abstract

Variables that determine overall survival (OS) in patients diagnosed with Hodgkin lymphoma (HL) and Non-HL have been widely studied in the United States. However, healthcare disparities exist within the different cancer subtypes and ethnic minorities. This is the first large statewide population-based study differentiating ethnicity, insurance status, and survival for HL, diffuse large B cell lymphoma (DLBCL), and primary central nervous system (PCNS) lymphoma in Texas. Retrospective analysis of patients with histopathologic proven disease recorded in the Texas Cancer Registry from 2006-2017 was carried out. Demographic, clinical, and survival variables were analyzed. Survival distributions were determined on Kaplan-Meier curves. Cox proportional hazards regression analysis was carried out in the subsequent review. From 2006-2017, 21,229 patients with HL, DLBCL, and PCNS were diagnosed in Texas (6,004, 14,366, and 859, respectively). Median survival was outstanding and superior for uninsured compared to insured patients. Survival probability at 2, 5, and 10 years among insured vs uninsured was noteworthy for the three malignancies. Overall survival (OS) was statistically significant for uninsured Hispanics with p-values of <0.0001 for HL and <0.0001 for DLBCL. However, for PCNS, uninsured non-Hispanics had the highest OS rate. Based on the Cox results, the significance of these results is significant for patients diagnosed with DLBCL and PCNS. For DLBCL and PCNS, the uninsured Hispanic population had significantly better survival. Although in HL the OS for Hispanics was outstanding, this effect seems to fade away with the adjustment of other covariables. This finding may be due to standardized treatment, immediate healthcare enrolling after diagnosis, and/or different community healthcare practices. Nonetheless, lack of insurance may delay diagnosis, necessitate multiple lines of chemotherapies, increase the rate of metastatic disease or recurrences. As more expensive and personalized therapies evolve, insurance status can limit access to these. Although we showed that insurance is no longer a determinant for improving OS within certain subsets of patients, it could have potential implications for other oncological outcomes.