For many cancer sites, it is unclear to what extent differences in health insurance coverage contribute to racial and ethnic disparities in stage III-IV diagnoses. Using the National Cancer Database (1,893,026 patients aged 18-64 years, diagnosed between 2013-2019), we investigated a potential mediating role of health insurance (privately insured vs uninsured) in explaining racial and ethnic disparities in stage at diagnosis of 10 cancers (ie, breast, prostate, colorectal, lung, cervical, uterine, bladder, head and neck, skin melanoma), detectable early through screening, physical examination, or clinical symptoms. The analyses provided evidence of mediation of non-Hispanic Black vs White disparities in eight cancers (range of proportions mediated: 4.5%-29.1%); Hispanic vs non-Hispanic White disparities in six cancers (13.2%-68.8%); non-Hispanic Asian/Pacific Islander vs White disparities in three cancers (5.8%-11.3%). To summarize, health insurance accounts for a significant proportion of the racial and ethnic disparities in stage III-IV diagnoses across a wide range of cancers.

中文翻译：

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健康保险对 10 种癌症晚期诊断中种族和民族差异的贡献


对于许多癌症部位，目前尚不清楚健康保险覆盖范围的差异在多大程度上导致了 III-IV 期诊断的种族和民族差异。使用国家癌症数据库（1,893,026 名年龄在 18-64 岁之间，在 2013-2019 年之间诊断的患者），我们调查了健康保险（私人保险与无保险）在解释 10 种癌症（即乳腺癌、前列腺癌、结直肠癌、肺癌、宫颈癌、子宫癌、膀胱癌、头颈部癌、皮肤黑色素瘤）诊断阶段的种族和民族差异的潜在中介作用，可通过筛查及早发现， 体格检查或临床症状。分析提供了 8 种癌症中非西班牙裔黑人与白人差异的中介证据（介导的比例范围：4.5%-29.1%）;西班牙裔与非西班牙裔白人在六种癌症中的差异 （13.2%-68.8%）;非西班牙裔亚裔/太平洋岛民与白人在三种癌症中的差异 （5.8%-11.3%）。总而言之，健康保险占各种癌症 III-IV 期诊断的种族和民族差异的很大一部分。