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Journal of the American Academy of Dermatology
Volume 74, n° 2
pages 309-316 (février 2016)
Doi : 10.1016/j.jaad.2015.09.054
accepted : 30 September 2015
Original Articles

Association of health insurance with outcomes in adults ages 18 to 64 years with melanoma in the United States

Arya Amini, MD, Chad G. Rusthoven, MD, Timothy V. Waxweiler, MD, Bernard L. Jones, PhD, Christine M. Fisher, MD, MPH, Sana D. Karam, MD, PhD, David Raben, MD
 Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 

Reprint requests: David Raben, MD, Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Ct, Room 1032, Aurora, CO 80045.

Studies evaluating insurance status and melanoma outcomes are limited.


We investigated whether health insurance correlates with more advanced disease, receipt of treatment, and survival in melanoma.


This was a cross-sectional analysis of 61,650 patients with cutaneous melanoma using the Surveillance, Epidemiology, and End Results database.


Under multivariate analysis, patients with either Medicaid insurance (hazard ratio, 1.83; 95% confidence interval [CI], 1.65-2.04; P  < .001) or uninsured status (hazard ratio, 1.63; 95% CI, 1.44-1.85; P  < .001) were more likely to die of any cause, including melanoma. Uninsured compared with non-Medicaid insured cases more often presented with increasing tumor thickness (odds ratio [OR], 2.19; 95% CI, 1.76-2.73; P  < .001) and presence of ulceration (OR, 1.64; 95% CI, 1.40-1.92; P  < .001), and less often received treatment (OR, 1.87; 95% CI, 1.60-2.19; P  < .001). Compared with non-Medicaid insured, Medicaid cases more often had increasing tumor thickness (OR, 2.36; 95% CI, 1.91-2.91; P  < .001), advanced stage (OR, 1.59; 95% CI, 1.37-1.85; P  < .001), and presence of ulceration (OR, 1.40; 95% CI, 1.19-1.63; P  < .001), and less often received treatment (OR, 1.61; 95% CI, 1.37-1.89; P  < .001).


This was a retrospective study.


Patients with melanoma and Medicaid or uninsured status were more likely to present with advanced disease and were less likely to receive treatment, likely contributing to an overall and cause-specific survival detriment. Addressing access to care may help improve these outcomes.

The full text of this article is available in PDF format.

Key words : Affordable Care Act, health care disparities, health insurance, malignant melanoma, treatment outcomes

Abbreviations used : CI, CSS, HR, OR, OS, SEER, SES

 Funding sources: None.
 Conflicts of interest: None declared.

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