Impact of Insurance Status on Survival Outcomes in Adults with Acute Lymphoblastic Leukemia (ALL): A Single Center Experience.

Abstract Background Socioeconomic factors including race, ethnicity and poverty level have been associated with disparities in survival among adult patients with acute leukemia. Insurance status is also likely to affect survival outcomes in these patients but has not been well studied. We investigated the impact of insurance status at time of diagnosis on survival in adult patients with acute lymphoblastic leukemia (ALL). Patients and methods Adult patients diagnosed with B-lineage ALL between January 1, 2007 and October 31, 2017 were included, with follow up through January 19, 2018. Kaplan-Meier survival curves were used to estimate overall survival (OS) and progression-free survival (PFS) for the two groups. Cox proportional hazard regression methods were used for univariate and multivariate analyses. Results A total of 136 patients were included in the study, 29 without insurance and 107 with insurance at time of diagnosis. Patients without insurance were younger and more likely to be Hispanic or Latino compared to insured patients. When controlling for confounding variables, patients without insurance had worse PFS. There was no statistically significant difference in OS between the two groups. Hispanic or Latino ethnicity was associated with improved PFS and OS in multivariate analyses. Conclusions Adult ALL patients without health insurance at time of diagnosis had worse PFS when controlling for other relevant clinical factors. Lack of insurance may be an obstacle to timely, effective maintenance therapy in the outpatient setting. Further research is needed to understand how insurance status impacts survival and ways to mitigate any disparities.