Impact of insurance coverage on diagnosis and surgical treatment of gastric malignancies in urban populations.

Abstract

e13783 Background: This study aims to investigate the influence of insurance coverage on the diagnosis and surgical management of gastric malignancies in urban populations.The study focuses on two groups: patients with Medicare, Medicaid, or charity care (public/uninsured group) versus those with private insurance. Staging and subsequent surgical intervention may be influenced by insurance type, which has implications for treatment outcomes in gastric cancer patients. Methods: Data was collected from a cohort of 109 patients diagnosed with gastric malignancies. Insurance coverage was categorized as either Medicare, Medicaid, charity care, or private insurance. Patients were also grouped based on the availability of pathological staging data. A total of 103 patients had some form of insurance information, with 84 covered by Medicare, Medicaid, or charity care and 19 having private insurance. Staging information was available for 58 patients, while 51 patients lacked documented pathology staging. It is notable that some patients that lacked pathological data had clinical evidence of metastatic or stage IV disease based on chart review. Results: From the 58 patients, 55 patients had both staging and insurance data. 46 were covered by Medicare, Medicaid, or charity care, and 9 had private insurance. Pathological stage (pTx) distribution in the Medicare/Medicaid/charity care group included pT0 (n = 1), pT1 (n = 7), pT2 (n = 11), pT3 (n = 21), and pT4 (n = 6). In the private insurance group, stage distribution was pT1 (n = 2), pT2 (n = 2), pT3 (n = 3), and pT4 (n = 2). Additionally, ethnic distribution revealed that among public/underinsured with staging patients, 22 were Hispanic, 13 Black/African American, 3 non-Hispanic White, 2 Asian American, and 6 from other ethnic groups. Among privately insured patients with staging, 4 were Hispanic, 2 Black/African American, and 3 non-Hispanic White. Conclusions: Insurance coverage affects both the diagnostic staging and treatment of gastric malignancies in urban populations. Patients with Medicare, Medicaid, or charity care tend to be diagnosed at later stages compared to those with private insurance. Furthermore, disparities in diagnosis and treatment are evident across different ethnic groups, with uninsured patients predominantly comprising Hispanic and Black populations. The findings underscore the need for policy interventions aimed at reducing healthcare disparities and improving access to timely and appropriate care for gastric cancer patients in underserved communities.