Insurance disparities among subgroups of Hispanic Americans with cancer.

Abstract

e13775 Background: Hispanic Americans, the second-largest racial/ethnic group in the U.S., make up approximately 19% of the population and experience complex disparities in accessing cancer care. Adequate insurance is crucial for cancer patients, yet little is known about insurance status among Hispanic Americans, especially within specific ethnic subgroups. Methods: We used data from the National Cancer Database (NCDB), from 2004 to 2021 on the most common cancers (breast, non-small-cell lung, prostate) among patients under 65. Insurance status was dichotomized as non-insurance/Medicaid vs. private/government/Medicare/other, and binary logistic regression was used to calculate odds ratios (ORs) for insurance status by Hispanic ethnic subgroups. Results: Our study included 664,164 patients with lung cancer, 2,119,494 with breast cancer patients, and 944,169 with prostate cancer. We found significant heterogeneity in insurance status among Hispanic American subgroups and similar patterns across the three most common cancer types (Table 1 for breast cancer). Compared to non-Hispanic White patients, Dominican patients were the second-most likely to be uninsured or on Medicaid among patients with breast cancer (odds ratio 6.34(CI 5.88-6.84), most likely subgroup among patients with lung cancer (OR 3.09 (CI 2.54-3.77), and most likely subgroup among patients with prostate cancer (OR 13.13 (CI 11.67-14.78). Mexican, Dominican, and South or Central American patients were consistently among the top three subgroups who were uninsured or had Medicaid across breast, lung, and prostate cancer. There was heterogeneity among Hispanic subgroups, as Cubans were consistently less likely to be uninsured or have Medicaid than Mexicans, South or Central Americans, Dominicans, and Puerto Ricans across all three cancers (all p < 0.005 except p = NS for Puerto Ricans with lung cancer). Every Hispanic subgroup was more likely to be uninsured or have Medicaid than White Americans (all p < 0.05). Conclusions: This study highlights insurance as a critical point of disparity in the cancer care journey for Hispanic patients. The disparities in insurance coverage among Hispanic subgroups call for a more nuanced understanding of the diverse social determinants of health that affect Hispanic subpopulations. Addressing these disparities could improve access to care and cancer outcomes for Hispanic Americans.