Health insurance a major factor in colorectal cancer survival disparities
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* Julia Haskins

Health insurance coverage has a significant impact on the survival rates of patients with colorectal cancer, contributing to disparities, according to a study published in the November issue of *Gastroenterology*.

According to the study, previous research has found that disparities in survival rates between older black and white patients with colon cancer could be attributed to differences in tumor characteristics. But as this study showed, insurance coverage is an even more significant factor in black-white survival rates for colorectal cancer patients, with differences in insurance accounting for about half of the disparity in survival rate, while tumor characteristics accounted for one-quarter of the black-white disparity.

Researchers looked at differences in insurance, comorbidity, tumor characteristics and treatment among more than 199,000 black and white patients with colorectal cancer between the ages of 18 and 64, using data from the National Cancer Database. Overall, the absolute five-year survival difference between black and white patients with colorectal cancer was 9.2 percent, at 57.3 percent for black patients and 66.5 percent for white patients. The survival difference decreased to 4.9 percent when matching for insurance status and 2.3 percent when matching for tumor characteristics.

A number of factors affecting people’s access to affordable health care may be attributed to disparities in coverage between black and white patients, such as differences in employment, income, education or wealth, according to lead study author Helmneh Sineshaw, MD, MPH, director of treatment patterns and outcomes research at the American Cancer Society. Availability of federal support, such as Medicaid expansion and health exchange subsidies, could also be part of the disparity, he said. Meanwhile, differences in tumor characteristics between black and white patients may be related to differences in access to screening or quality care as well as biological differences.

The findings underscore the need for equity in health insurance coverage, Sineshaw said.

“Our study documented that affordable health insurance coverage for all populations could substantially reduce differences in survival times of black versus white patients with (colorectal cancer),” he told The Nation’s Health. “This study will help inform policymakers, clinicians, patients and advocates that there is remarkable black-white survival disparity among nonelderly colorectal cancer patients, which could be substantially reduced by improving availability of equitable health insurance coverage for all populations.”

For more information, visit [http://www.gastrojournal.org/article/S0016-5085(17)36351-5/pdf](http://www.gastrojournal.org/article/S0016-5085(17)36351-5/pdf).

*   Copyright The Nation’s Health, American Public Health Association