The influence of insurance type on stage at presentation, treatment, and survival between Asian American and non-Hispanic White lung cancer patients

The effect of insurance type on lung cancer diagnosis, treatment, and survival in Asian patients living in the United States is still under debate. We have analyzed this issue using the Surveillance, Epidemiology, and End Results database. There were 102,733 lung cancer patients age 18-64years diagnosed between 2007 and 2013. Multilevel regression analysis was performed to identify the association between insurance types, stage at diagnosis, treatment modalities, and overall mortality in Asian and non-Hispanic White (NHW) patients. Clinical characteristics were significantly different between Asian and NHW patients, except for gender. Asian patients were more likely to present with advanced disease than NHW patients (ORadj = 1.12, 95% CI = 1.06-1.19). Asian patients with non-Medicaid insurance underwent lobectomy more than NHW patients with Medicaid or uninsured; were more likely to undergo mediastinal lymph node evaluation (MLNE) (ORadj = 1.98, 95% CI = 1.72-2.28) and cancer-directed surgery and/or radiation therapy (ORadj = 1.41, 95% CI = 1.20-1.65). Asian patients with non-Medicaid insurance had the best overall survival. Uninsured or Medicaid-covered Asian patients were more likely to be diagnosed with advanced disease, less likely to undergo MLNE and cancer-directed treatments, and had shorter overall survival than their NHW counterpart.