Lindsey, L.

Disparity in forgoing medical care across race/ethnicity groups among adult survivors of childhood cancer.
LA, Lindsey, IC. Huang, TM. Brinkman, C. Howell, K.K. Ness, M.J., Ehrhardt, T.M. Gibson, N. Bhakta, M.M. Hudson, L.L. Robison, Y. Yasui

Forgoing 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. Here, we assessed disparity across race/ethnicity groups in access to care characterized by "forgoing medical care in the last two years" using 3,275 adult survivors participating in the St. Jude Lifetime Cohort Study (SJLIFE).

Multivariable logistic regression analysis adjusting for age, sex, cancer diagnosis, treatment modalities, treatment era, and perceived health status showed that,

compared to Non-Hispanic (NH) Whites (NH) with private health insurance, adjusted odds ratios (ORs) of having foregone care were: for NH Whites with public insurance, OR=0.88, 95% Confidence Interval (CI) 0.68-1.16, p-value=0.37; for NH Whites with no insurance, OR=4.63, 95%CI 3.59-5.98, p-value<0.0001; for NH Blacks with private insurance, OR=2.02, 95%CI 1.40-2.90 p-value=0.0001; for NH Blacks with public insurance, OR=1.07, 95%CI 0.69-1.64, p-value=0.78; and for NH Blacks with no insurance, OR=8.93, 95%CI 5.69-14.01, p-value<0.0001. Hispanics, on the other hand, showed less foregone care, although not statistically significantly, than NH Whites with private insurance: for Hispanics with private insurance OR=0.28, 95%CI 0.06-1.24, p-value=0.09; for Hispanics with public insurance OR=0.98, 95%CI 0.18-5.50, p-value=0.99; and for Hispanics with no insurance OR=0.84, 95%CI 0.26-2.68, p-value=0.76.

These results showed: 1) NH Blacks forgo medical care approximately twice more frequently than NH whites, unless they have public insurance; 2) under public insurance, there is no difference in forgoing 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.