Clinical Edge

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Insurance Status & Stage of Prostate Ca Diagnosis

Cancer Epidemiol; 2019 Apr; Ramirez, Morano, et al

Insurance status may modify the effect of race on late state prostate cancer in black patients, a new study found. Researchers investigated whether insurance status was a modifier of the association between race and state of previously undetected prostate cancer at the time of diagnosis in Florida between 1995 and 2013. The secondary analysis of a cross-sectional survey used information from the Florida Cancer Data System (n=224,819) and participants included black and white males diagnosed with prostate cancer in Florida during the study period. The primary outcome was state of prostate cancer at diagnosis. Among the findings:

  • Black males were more likely to be diagnosed with late stage prostate cancer vs white males.
  • Being uninsured or having Medicaid was associated with a diagnosis of late stage cancer.
  • In stratified analysis, black males had an increased risk for late stage cancer if uninsured and if having Medicare.


Ramirez E, Morano J, Beguiristain T, et al. Insurance status as a modifier of the association between race and state of prostate cancer diagnosis in Florida during 1995 and 2013. Cancer Epidemiol. 2019;59:104-108. doi:10.1016/j.canep.2019.01.019.


It is well known that African-American men have a significantly higher risk for 1) developing prostate cancer and 2) dying from prostate cancer compared with other racial groups. However, elucidating why this is the case has been challenging and a very important issue to address. The authors hypothesized that the type of insurance and presence or absence of insurance may play a role. They found that being uninsured or having Medicaid was associated with an increased risk of presentation with late stage prostate cancer. Their findings have important implications for future study design and policy development. —Mark A. Klein, MD