Effect of Type of Health Insurance Coverage on Leukemia Survival in Adults in Puerto Rico

Abstract

Objective: In Puerto Rico, leukemia is among the top 10 cancers in terms of incidence and mortality. The aim of the study described herein was to establish the overall leukemia survival rate in Puerto Rico and determine whether there are differences in leukemia survival by type of health insurance coverage. Methods: Data for adult patients (aged >20 years) diagnosed with leukemia were provided by the Puerto Rico Central Cancer Registry. The relative survival rates (1, 3, and 5 years) were estimated for leukemia patients (diagnosed from 2004 through 2006) by type of health insurance (government health plan [GHP] or non-government health plan [NGHP]). Relative survival is defined as observed survival in the cohort divided by expected survival in the cohort. A Poisson regression model was used to analyze the relative excess risk of death for both the GHP and the NGHP groups. Results: A total of 516 leukemia patients were eligible for analysis. The overall survival rates of leukemia patients in PR for 1, 3, and 5 years after diagnosis were 55.8%, 40.5%, and 34.7%, respectively. Relative survival rates were lower for patients with GHP (1 year = 52.8%; 3 years = 36.4%; 5 years = 32.2%) than they were in people with NGHP (1 year = 57.5%; 3 years = 42.8%; 5 years = 36.1%). Among patients aged 65+ years, those with GHP had a 1.58-fold (95% CI: 1.11-2.27) higher risk of death than did those patients with NGHP. Conclusion: Several factors could explain the disparities observed in leukemia survival rates (as grouped by health insurance status) in PR. Some of them include differences in patterns of healthcare coverage, in delays in treatment, in quality of service, in risk factors, and co-morbidities present in the older population studied.