This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Park, E. R. Articles by Mertens, A. C. Search for Related Content PubMed PubMed Citation Articles by Park, E. R. Articles by Mertens, A. C.

Health Insurance Coverage in Survivors of Childhood Cancer: The Childhood Cancer Survivor Study

From the Massachusetts General Hospital/Harvard Medical School; Dana-Farber Cancer Institute/Harvard School of Public Health, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California-San Francisco, San Francisco, CA; Department of Pediatrics, University of Minnesota, Minneapolis, MN

Address reprint requests to Elyse R. Park, PhD, Massachusetts General Hospital/Harvard Medical School, 50 Staniford St, 9th floor, Boston, MA 02114; e-mail: epark{at}partners.org

PURPOSE: To examine the prevalence and predictors of health insurance coverage and the difficulties obtaining coverage in a large cohort of childhood cancer survivors.

PATIENTS AND METHODS: This study included 12,358 5-year survivors of childhood cancer and 3,553 sibling controls participating in the Childhood Cancer Survivor Study. Data were collected by surveys distributed in 1994 (baseline) and 2000 (follow-up).

RESULTS: At baseline, 83.9% of adult survivors, compared with 88.3% of siblings, had health insurance coverage (P < .01); 6 years later, small but significant survivor-sibling differences remained (88% v 91%; P < .01). Twenty-nine percent of survivors reported having had difficulties obtaining coverage, compared with only 3% of siblings (P < .01). In multivariate analysis of survivors 18 years of age or older, factors associated with being uninsured included younger age at diagnosis (diagnosis age of 0 to 4 years; odds ratio [OR] = 1.7; 95% CI, 1.3 to 2.2), male sex (OR = 1.3; 95% CI, 1.2 to 1.5), age at baseline survey (age 22 to 24 years; OR = 1.6; 95% CI, 1.2 to 2.1), lower level of attained education (less than high school, OR = 2.6, 95% CI, 2.1 to 3.3; high school graduate, OR = 2.1, 95% CI, 1.8 to 2.5), income less than $20,000 (OR = 5.6, 95% CI, 4.5 to 7.1), marital status (widowed/divorced/separated; OR = 1.3; 95% CI, 1.1 to 1.6), smoking status (current smoker, OR = 2.0, 95% CI, 1.7 to 2.3; former smoker, OR = 1.4, 95% CI, 1.2 to 1.8), and treatment that included cranial radiation (OR = 1.3, 95% CI, 1.0 to 1.6).

CONCLUSION: Compared with siblings, adult survivors of childhood cancer had significantly lower rates of health insurance coverage and more difficulties obtaining coverage. Since lack of coverage likely has serious health and financial implications for this at-risk population, any disparity in availability and quality of coverage is of great concern.

Supported by Grant U24 CA55727 from the National Cancer Institute, Bethesda, MD, and support provided to the University of Minnesota from the Children's Cancer Research Fund, Minneapolis, MN.

Other investigators and institutions participating in the Childhood Cancer Survivors Study are listed in the Appendix (available online only).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

This article has been cited by other articles:

				R. Mody, S. Li, D. C. Dover, S. Sallan, W. Leisenring, K. C. Oeffinger, Y. Yasui, L. L. Robison, and J. P. Neglia Twenty-five-year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study Blood, June 15, 2008; 111(12): 5515 - 5523. [Abstract] [Full Text] [PDF]

				J. D. Dickerman The Late Effects of Childhood Cancer Therapy Pediatrics, March 1, 2007; 119(3): 554 - 568. [Abstract] [Full Text] [PDF]