Health insurance continuity and mortality in children, adolescents, and young adults with blood cancer.
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BACKGROUND: Many uninsured patients do not receive Medicaid coverage until a cancer diagnosis, potentially delaying access to care for early cancer detection and treatment. We examined the association of Medicaid enrollment timing and patterns with survival among children, adolescents, and young adults with diagnosed blood cancers, where disease onset can be acute and early detection is critical. METHODS: We identified 28 750 children, adolescents, and young adults (birth to 39 years of age) with newly diagnosed blood cancers from the 2006-2013 Surveillance, Epidemiology, and End Results program-Medicaid data. Enrollment patterns included continuous Medicaid enrollment (preceding through diagnosis), newly gained Medicaid coverage (at or shortly after diagnosis), other noncontinuous Medicaid enrollment, and private/other insurance. We assessed cumulative incidence of death from diagnosis, censoring at last follow-up, 5 years after diagnosis, or December 2018, whichever occurred first. Multivariable survival models estimated the association of insurance enrollment patterns with risk of death. RESULTS: One-fourth (26.1%) of the cohort was insured by Medicaid; of these patients, 41.1% had continuous Medicaid enrollment, 34.9% had newly gained Medicaid, and 24.0% had other or noncontinuous enrollment. The cumulative incidence of all-cause death 5 year after diagnosis was highest in patients with newly gained Medicaid (30.2%, 95% confidence interval [CI] = 28.4% to 31.9%), followed by other noncontinuous enrollment (23.2%, 95% CI = 21.3% to 25.2%), continuous Medicaid enrollment (20.5%, 95% CI = 19.1% to 21.9%), and private/other insurance (11.2%, 95% CI = 10.7% to 11.7%). In multivariable models, newly gained Medicaid was associated with a higher risk of all-cause death (hazard ratio = 1.39, 95% CI = 1.27 to 1.53) and cancer-specific death (hazard ratio = 1.50, 95% CI = 1.35 to 1.68) compared with continuous Medicaid. CONCLUSIONS: Continuous Medicaid coverage is associated with survival benefits among pediatric, adolescent, and young adult patients with diagnosed blood cancers; however, fewer than half of Medicaid-insured patients have continuous coverage before diagnosis.