Children and teenagers diagnosed with cancer in the U.S. can have a very different chance of survival based on the type of health insurance they have, according to new research from the Brown School at Washington University.
The study, which analyzed the records of tens of thousands of young cancer patients, finds those on Medicaid had a higher risk of death and shorter overall survival compared to privately insured patients. But researchers caution that these results likely reflect the complex socioeconomic challenges facing families on Medicaid, rather than the quality of the insurance itself.
Childhood cancer in the U.S. remains relatively rare, with death rates declining across all races and age groups in recent years. Deaths from childhood cancer dropped by 20% from 1999 to 2014, according to the National Center for Health Statistics.
Though medical advances have boosted the five-year cancer survival rate among kids and adolescents to about 85%, survival still varies substantially based on socioeconomic status and race.
To understand whether insurance coverage also plays a role, the team analyzed the records of more than 58,000 children and teenagers diagnosed with cancer in the U.S. from 2004 to 2010.
Medicaid patients were more likely to live in low-income areas and identify as Black, Latino or another racial minority.
These young patients insured through Medicaid also tended to be diagnosed with cancer at a later stage. They died about two months earlier on average and had a higher overall risk of death, compared to those with private insurance.
But the type of insurance itself may not be what’s driving differences in survival.
Medicaid is a “marker of socioeconomic status” in the U.S., said cancer epidemiologist and study co-author Kim Johnson — and families that rely on government-funded health coverage often face other challenges, such as housing and food insecurity.
“You can imagine how hard it would be, even if you have a lot of resources, to go through a cancer diagnosis with your child,” said Johnson, an associate professor in the Brown School. “I think that it's even harder for families who are already struggling financially.”
It’s also possible that some Medicaid patients experience gaps in insurance coverage, said Wash U graduate student and co-author Xiaoyan Wang.
She said they plan to continue exploring these patterns to better understand this “particularly vulnerable” group of patients.
“We want to reveal the underlying reasons why children and adolescents with Medicaid have lower survival,” said Wang. “Hopefully, if we can find the reasons for this, we can continue to improve it.”
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