In health outcomes, money talks
Young people with lymphoma with uninterrupted insurance coverage had earlier stage disease, and income levels were associated with death risk for young adults with type 2 diabetes, show studies.
News flash: Having better access to health care and being able to pay for it can result in better outcomes for patients.
That’s the message of two recently published studies, one looking at insurance coverage for children and young adults with lymphoma; the other comparing death rates among patients with type 2 diabetes, stratified by income levels.
Medicaid Coverage
Children and adolescents/young adults who were already on Medicaid and had uninterrupted coverage were significantly more likely, when diagnosed with either Hodgkin or non-Hodgkin lymphoma, to have earlier-stage disease compared with their peers who were either newly enrolled or had only sporadic Medicaid coverage.
These findings are from a study by Xu Ji, PhD, from Emory University School of Medicine and Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta, and colleagues, is published by the journal Blood Advances.
The researchers conducted a study of 3,524 children or adolescents/young adults with Hodgkin or non-Hodgkin lymphoma whose data were included in both the CDC’s Surveillance, Epidemiology, and End Results (SEER) cancer registry and Medicaid enrollment database.
The purpose of the study was to see whether timing of Medicaid enrollment and continuity of coverage might have an effect on patient outcomes.
“Many people do not enroll in Medicaid, despite being eligible, until something happens, such as a cancer diagnosis,” Ji said. “However, it may be too late at that point because they have lost the opportunity to access preventive or primary care for early evaluation of signs and symptoms and timely referral to oncologists for diagnostic testing and therapy initiation.”
They found that 38% of the patients had been enrolled for at least a year before diagnosis, 35% were enrolled within a month or two before or after the diagnosis, and 27% were enrolled sometime either within a year of diagnosis or two months after the diagnosis of lymphoma (referred to in the study as “other enrollment patterns”).
Those most likely to be continuously enrolled in Medicaid were patients of Hispanic origin, non-Hispanic Blacks, children under 14, and patients from low-income neighborhoods.
Nearly one-third of the patients (32.2%) had the most advanced stage of disease, stage IV, at the time of diagnosis. After controlling for factors that might skew the results—including sex, race/ethnicity, age at diagnosis, rural vs. urban residence, neighborhood socioeconomic status and year of diagnosis—the researchers found that the probability of having stage IV disease at diagnosis was 40% for newly enrolled patients, 31% for those with other enrollment patterns, and 26% for those had been continuously enrolled.
“These results show that continuous Medicaid coverage was strongly linked to a lower likelihood of a late-stage lymphoma diagnosis,” said Ji.
Death and diabetes
In the second study, Ji Yoon Kim, MD, PhD and colleagues from University College of Medicine in Seoul, South Korea, looked at the relationship between overall and cause-specific rates of death among patients with type 2 diabetes (T2D) and their age and income levels.
They examined data on all adults aged 20 through 79 years in South Korea who were diagnosed with type 2 diabetes between 2008 and 2013, and were followed through the end of 2019.
The study sample included 1,240,780 persons with type 2 diabetes and 635,805 without diabetes, who served as controls. The controls were matched to the diabetes cohort by age and sex.
The investigators saw that the higher the income, the lower the risk of death from any cause, especially among patients from 20 through 39 years of age. The patients in this group with the lowest income levels had a nearly three-fold higher risk for all-cause mortality compared with the highest income group. The death gap between the rich and the poor narrowed over time but still remained statistically significant, with lower-income diabetic patients from the ages of 40 to 59 having nearly double the risk of death from any cause as the higher income patients. Among low income patients with diabetes from the ages of 60 to 79, the risk of all-cause mortality was 1.26 times higher than for their more affluent peers.
Deaths from cardiovascular disease appeared to account for most of the income-related disparities, the researchers said.
The study “provides epidemiologic evidence of the need for health care policies targeting young people with T2D. More efforts at the social and national level should be made to reduce the disparities in health outcomes according to socioeconomic status among young adults with T2D,” Kim and colleagues wrote.
The study is published in the open-access journal JAMA Network Open.
The study by Ji and colleagues was supported by a grant from the Leukemia & Lymphoma Society. Ji reported having no conflict of interest to declare.
Kim and colleagues did not report a study funding source. They reported having no conflicts of interest to declare.
Neil Osterweil is an award-winning medical journalist with more than 40 years of experience reporting on medicine and health care.