Journal: Cancer medicine
This population-based study used data from 5,782 children with cancer diagnosed between 2000–2020 in Iowa and Louisiana to examine whether health insurance at diagnosis mediates the relationship between neighborhood deprivation and cancer-specific survival.
Neighborhood deprivation was quantified using the Area Deprivation Index. Log-binomial models evaluated predictors of insurance type (private vs non-private), and Cox regression assessed associations between insurance and cancer-specific survival. Causal mediation analysis tested insurance as a mediator between deprivation and survival.
- Children living in more deprived neighborhoods, non-White children, and children in Louisiana were more likely to have non-private insurance.
- Compared with privately insured children, those with non-private insurance had a significantly higher hazard of cancer death (adjusted HR 1.32, 95% CI 1.13–1.55).
- Insurance status mediated only a modest portion (about 7%–15%) of the association between neighborhood deprivation and cancer-specific survival.
The authors conclude that while insurance coverage partially explains neighborhood-level disparities in pediatric cancer outcomes, most of the disparity appears driven by broader structural and systemic factors beyond individual insurance status.