Disparity in Forgoing Medical Care Across Race/Ethnicity Groups Among Long-term Adult Survivors of Childhood Cancer

• Author / Creator

  Lindsey, Lauren A.

• Background: Foregoing medical care is of concern among adult childhood cancer survivors because they are at high-risk for developing a variety of chronic health conditions due to exposures to cancer treatment in childhood.
  
  Objectives: I assessed disparity across race/ethnicity groups in access to care characterized by “foregoing medical care in spite of the needs in the last two years” using 3,275 adult survivors of childhood cancer participating in the St. Jude Lifetime Cohort Study (SJLIFE).
  Methods: Using a cross-sectional design, I examined foregoing medical care in the last two years by race/ethnicity and insurance type (private, public and no insurance), using multivariable logistic regression, adjusting for age, gender, cancer diagnosis, treatment modalities, and treatment era, with and without perceived health status and personal income.
  Results: Compared to Non-Hispanic (NH) Whites with private health insurance, the adjusted odds ratios (OR) of having foregone care was 0.88 [95% Confidence Interval (CI) 0.68–1.16] for NH Whites with public insurance. For NH Whites with no insurance, the OR was 4.63 [95%CI 3.59–5.98]. Among NH Blacks, for those with private insurance, the OR was 2.02 [95% CI 1.40–2.90] compared to NH Whites with private health insurance. The OR was 1.07 [95%CI 0.69–1.64] for NH Blacks with public insurance, the OR was 8.93 [95%CI 5.69–14.01] compared to NH Whites with private health insurance. Hispanics, on the other hand, showed less foregone care, although not statistically significantly, than NH Whites with private insurance: with HIS private insurance OR=0.28 [95%CI 0.06–1.24]; with HIS public insurance OR=0.98 [95%CI 0.18–5.50]; and with HIS no insurance OR=0.84 [95%CI 0.26–2.68]. While the additional adjustment for income and education attenuated these associations, the pattern of associations remained the same and statistically significant.
  
  Conclusion: These findings showed: 1) NH Blacks forgo medical care approximately two times more frequently than NH whites, unless they have public insurance; 2) under public insurance, there is no difference in foregoing care across the race/ethnicity groups; 3) not having insurance more than quadruples the likelihood of foregoing care among NH Whites and NH Blacks; and 4) Hispanics seem to have means for not foregoing care regardless of their insurance status. Provision of public insurance to all may eliminate these large disparities.

• Subjects / Keywords

  • Health Disparities

• Graduation date

  Spring 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-yeg9-b413

• License

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