Survival outcomes for AML patients with different types of insurance: A US study

Acute Myeloid Leukemia (AML) patients who have delays in either diagnosis or treatment have a much compromised survival. Moreover, social and economic disparities may affect the survival outcomes of some AML patients. Additionally, there are conflicting reports on the survival outcomes of AML patients who are uninsured or have Medicaid (a United States [US] government social health insurance program),^1,2 hence the rational for this study.

Dianne Pulte and colleagues from the German Cancer Research Center (DKFZ), Heidelberg, Germany, reported in Leukemia Research the survival outcomes of AML patients diagnosed in the US by insurance type³. The results were published ahead of print on 3^rd February 2017.

Using the population based Surveillance Epidemiology and End Results (SEER)-18 registry, the authors identified 10,690 AML patients (15–64 years old) diagnosed in the US between 2007 and 2013. Patients were either uninsured (n = 619), insured with Medicaid (n = 2,033), or had other insurance (Medicare and private insurance, n = 7,721). Three percent (n = 317) of patients had their insurance information missing.

The key results of the study were:

• 1-year Overall Survival (OS) for patients with Medicaid, no insurance, and other insurance; 48.7% vs 46.0% vs 58.9%, respectively
•  5-year OS for patients with Medicaid, no insurance, and other insurance; 24.7% vs 25.6% vs 35.7%, respectively
• Compared to other insurance, Hazard Ratio (HR) for OS in uninsured and Medicaid AML patients; 1.32 vs 1.39, P < 0.0001
• Compared to other insurance, HR for AML-specific survival in uninsured and Medicaid AML patients; 1.33 vs 1.29, P < 0.0001

Uninsured and Medicaid AML patients have lower survival outcomes compared to AML patients with other insurance in the US.

However, the authors noted that their study had several limitations including lack of information on treatment regimen, lack of information on comorbidities, lack of information on prognostic factors, and lack of information on insurance status over the course of the illness. Hence, the role of these factors on survival could not be assessed and thus the effects of being uninsured and having Medicaid on survival might be underestimated.

The authors propose that additional research is required to investigate the reasons of poor survival outcomes in AML patients with Medicaid. They also suggested that urgent efforts are required to reduce the number of people uninsured so as to improve the outcomes of the AML population.

Abstract

Survival for patients with acute myeloblastic leukemia (AML) has increased during the past two decades. However, socioeconomic disparities may affect survival for some patient populations. We examine survival by insurance type for patients with AML. Using data from the Surveillance, Epidemiology, and End Results database we estimated survival according to insurance status (no insurance, Medicaid, and other insurance) for patients diagnosed with AML in the United States in 2007–2013. One, 3-, and 5-year survival was lower for patients with no insurance and Medicaid than for patients with other insurance. Five-year survival estimates were 24.7%, 25.6%, and 35.7%, respectively, for patients with Medicaid, no insurance, and other insurance. After adjustment, hazard ratios of 1.46 for uninsured and 1.35 for Medicaid compared to other insurance for overall survival and 1.50 for uninsured and 1.30 for Medicaid compared to other insurance for AML-specific survival were observed. Similar results were seen in all ages and both genders. Patients with no insurance or Medicaid have lower survival expectations after diagnosis with AML than patients with other insurance. Further research into reasons for the poor outcomes for Medicaid patients and continued reduction of number of uninsured people are urgently needed to improve population-level outcomes for AML.