Differences in insurance status among Asian Americans with cancer: A disaggregated analysis by ethnic subgroup.

Abstract

1529 Background: Asian Americans, the fastest-growing racial/ethnic group in the U.S., experience significant variation in barriers to cancer care access, yet most research treats them as a monolithic group. Insurance is crucial for accessing cancer care, but limited data exist on non-insurance rates among Asian Americans. This study investigates the heterogeneity in insurance status across Asian American subgroups in the context of common cancers. Methods: We analyzed data from the National Cancer Database (NCDB), and focused on breast, prostate, and non-small-cell lung cancers among patients under 65. Insurance status was dichotomized as non-insured/Medicaid versus private/government/Medicare/other, and binary logistic regression was used to calculate odds ratios (ORs) for insurance status by Asian American subgroups. Results: There were 2,161,947 patients with breast cancer, 603,172 with lung cancer, and 964,423 with prostate cancer. We found significant heterogeneity in insurance status among Asian American subgroups; such heterogeneity was mirrored across the three most common cancer types. Consistently, Japanese Americans were less likely to be uninsured or have Medicaid than White Americans (4.5%, 2.5%, and 12.2%, for patients with breast, prostate, and lung cancer, respectively, among Japanese-Americans vs. 10.2%, 5.5%, and 20.7% among White Americans, (odds ratio 0.54(95% CI: 0.47-0.61) for breast, 0.55(0.37-0.83) for prostate, 0.72(0.56-0.91) for lung), while every other Asian subgroup was significantly more likely to be uninsured or have Medicaid than White Americans (OR range 1.24 to 7.23 for breast, 1.25 to 10.42 for prostate, 1.12 to 6.39 for lung, all p-values <0.05 except for Laotians, Hmongs, and Thai with prostate cancer). Pakistani Americans were the group most likely to be uninsured or on Medicaid among patients with breast cancer (OR 7.22 (6.17-8.46) and prostate cancer (OR 10.41 (7.08-15.33) and were the second-most likely subgroup among patients with lung cancer (OR 4.82 (3.21-7.23). Hmong and Kampuchean were among the top three groups with breast or lung cancer who were uninsured or on Medicaid. Conclusions: Significant heterogeneity exists in insurance coverage among Asian American subgroups, which highlights the diversity of disparities Asian American patients face; these findings call into question the model minority myth, as every other Asian American subgroup besides Japanese-American was significantly less likely to be insured than White Americans. Asian American patients have broad differences in histories, social determinants of health, and barriers to accessing care, which may merit differentially targeted health interventions among certain subgroups.