Background: Studies have demonstrated that early diagnosis and receiving appropriate treatment may greatly increase the chances of survival of cancer patients. Although sociodemographic factors and the type of insurance status have been shown to be associated to the patient's survival, fewer studies have considered the joint effects of these variables on disease outcomes, particularly among Hispanics. Studies have shown that access to health insurance influences the quality of the health-care received. To ensure access to health and to eliminate disparities in medical care, the government of Puerto Rico (PR) implemented during the 1990's a Health Care Reform. The PR Government Health Care (GHC) program is available for medically indigent citizens and it covers approximately 40% of the Puerto Rican population. Objective: This study aimed to describe the 3-year relative survival of cervical cancer in PR and evaluate the effect of the type of health insurance coverage (GHC vs. Non-GHC) on patient's survival.
Methods: Women with a diagnosis of cervical cancer reported to the Puerto Rico Central Cancer Registry database from 2004 to 2005 were linked with health insurance claims data from the GHC from the same time period, to identify GHC patients (61.6%) and those without GHC coverage (38.4%). The maximum relative survival ratio was compared by health insurance groups. A Poisson regression model was used to assess relative excess risks of death.
Results: In the period 2004–2005, 333 out of the 344 (96.8%) primary cases of invasive cervical cancer reported among residents of PR were eligible for analysis. A higher than expected percent of the cases had GHC (62%) as compared to the general population in PR (40%). The higher percent of cases were among women 35–49 years-old (36%). When the effect of Health Care Plan was analyzed, the overall 3-year relative survival was 65.7% for GHC women and 78.9% for Non-GHC women. Consistent with previous studies, 3-year relative survival decreased with more advanced disease stage: 82% at localized, 62% at regional and 29% at distant. Survival was also lower among cases with GHC (77% at localized, 54% at regional and 25% at distant) than among those with Non-GHC (88% at localized, 78% at regional and 35% at distant), at all cancer stages. Analyses of the excess of risk showed that the GHC patients had a 2.1 (p=0.004) increased risk of death than Non-GHC patients, after adjusting for age and stage.
Conclusions: Three-year relative survival is lower among women in PR with cervical cancer who have GHC as compared to their counterparts. This study shows disparities related to health care coverage among a United States (US) Hispanic population living outside the US that warrants further research. This study will help to formulate strategies to improve cervical cancer survival and to reduce inequalities in cancer care.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A76.