ArticleBMC public health2012
Effects of being uninsured or underinsured and living in extremely poor neighborhoods on colon cancer care and survival in California: historical cohort analysis, 1996-2011.
Article in BMC public health, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed.
- Effect of insurance status on mortality following surgical treatment of colorectal cancers in the United States.Scientific reports · 2026Article
- Outcomes Among Patients With Colon Cancer Living in Neighborhoods With Persistent Poverty.JAMA network open · 2026Article
- Primary Care Provider Visits Among Cancer Survivors 5-7 Years Postdiagnosis.JCO oncology practice · 2025Article
- Follow-up surveillance among colorectal cancer survivors of different sexual orientations.Journal of cancer survivorship : research and practice · 2022Article
- The impact of socioeconomic status on survival in stage III colon cancer patients: A retrospective cohort study using the SEER census-tract dataset.Cancer medicine · 2021Article
- Palliative chemotherapy among people living in poverty with metastasised colon cancer: facilitation by primary care and health insurance.BMJ supportive & palliative care · 2019Article
- Neighborhood Characteristics and Colorectal Cancer Survivors' Quality of Care.Health equity · 2019Article
- Trends in Cancer Survival by Health Insurance Status in California From 1997 to 2014.JAMA oncology · 2018Article
- Breast Cancer Care in California and Ontario: Primary Care Protections Greatest Among the Most Socioeconomically Vulnerable Women Living in the Most Underserved Places.Journal of primary care & community health · 2017Article
- Self-Administered Outpatient Antimicrobial Infusion by Uninsured Patients Discharged from a Safety-Net Hospital: A Propensity-Score-Balanced Retrospective Cohort Study.PLoS medicine · 2015Article
- Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada.International journal for equity in health · 2015Article
- Care and survival of Mexican American women with node negative breast cancer: historical cohort evidence of health insurance and barrio advantages.Journal of immigrant and minority health · 2015Article
- Breast Cancer among Women Living in Poverty: Better Care in Canada than in the United States.Social work research · 2015Article
- Multiplicative disadvantage of being an unmarried and inadequately insured woman living in poverty with colon cancer: historical cohort exploration in California.BMC women's health · 2015Article
- Lack of access to chemotherapy for colon cancer: multiplicative disadvantage of being extremely poor, inadequately insured and African American.BMC health services research · 2014Article
- Health insurance mediation of the Mexican American non-Hispanic white disparity on early breast cancer diagnosis.SpringerPlus · 2013Article
- Better colon cancer care for extremely poor Canadian women compared with American women.Health & social work · 2013Article
- Mediation of the effects of living in extremely poor neighborhoods by health insurance: breast cancer care and survival in California, 1996 to 2011.International journal for equity in health · 2013Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundWe examined the mediating effects of health insurance on poverty-colon cancer care and survival relationships and the moderating effects of poverty on health insurance-colon cancer care and survival relationships among women and men in California.
methodsWe analyzed registry data for 3,291 women and 3,009 men diagnosed with colon cancer between 1996 and 2000 and followed until 2011 on lymph node investigation, stage at diagnosis, surgery, chemotherapy, wait times and survival. We obtained socioeconomic data for individual residences from the 2000 census to categorize the following neighborhoods: high poverty (30% or more poor), middle poverty (5-29% poor) and low poverty (less than 5% poor). Primary health insurers were Medicaid, Medicare, private or none.
resultsEvidence of mediation was observed for women, but not for men. For women, the apparent effect of poverty disappeared in the presence of payer, and the effects of all forms of health insurance seemed strengthened. All were advantaged on 6-year survival compared to the uninsured: Medicaid (RR = 1.83), Medicare (RR = 1.92) and private (RR = 1.83). Evidence of moderation was also only observed for women. The effects of all forms of health insurance were stronger for women in low poverty neighborhoods: Medicaid (RR = 2.90), Medicare (RR = 2.91) and private (RR = 2.60). For men, only main effects of poverty and payers were observed, the advantaging effect of private insurance being largest. Across colon cancer care processes, Medicare seemed most instrumental for women, private payers for men.
conclusionsHealth insurance substantially mediates the quality of colon cancer care and poverty seems to make the effects of being uninsured or underinsured even worse, especially among women in the United States. These findings are consistent with the theory that more facilitative social and economic capital is available in more affluent neighborhoods, where women with colon cancer may be better able to absorb the indirect and direct, but uncovered, costs of care.
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