Effects of health insurance and race on colorectal cancer treatments and outcomes

Objectives. We hypothesized that health insurance payer and race might influence the care and outcomes of patients with colorectal cancer. Methods. We examined treatments received for all incident cases of colorectal cancer occurring in Florida in 1994 (n=9551), using state tumor registry data. We also estimated the adjusted risk of death (through 1997), using proportional hazards regression analysis controlling for other predictors of mortality. Results. Treatments received by patients varied considerably according to their insurance payer. Among non-Medicare patients, those in the following groups had higher adjusted risks of death relative to commercial fee-for-service insurance: commercial HMO (risk ratio [RR]=1.40; 95% confidence interval [CI]=1.18, 1.67; P=.0001), Medicaid (RR=1.44; 95% CI=1.06, 1.97; P=.02), and uninsured (RR=1.41; 95% CI=1.12, 1.77; P=.003). Non-Hispanic African Americans had higher mortality rates (RR=1.18; 95% CI=1.01, 1.37; P=.04) than non-Hispanic Whites. Conclusions. Patients with colorectal cancer who were uninsured or insured by Medicaid or commercial HMOs had higher mortality rates than patients with commercial fee-for-service insurance. Mortality was also higher among non-Hispanic African American patients.