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Study Shows Health Insurance Status Mediates Racial and Ethnic Inequities in Advanced-Stage Cervical Cancer

July 2023 Vol 16, No 4 – Online Only

Health insurance coverage mediated racial and ethnic inequities among patients with advanced-stage cervical cancer, according to findings from a recent retrospective, cross-sectional, population-based study.1

“Previous studies have found that cervical cancer outcomes, including stage at diagnosis and survival, are associated with insurance status,” Hunter K. Holt, MD, MAS, Assistant Professor, Department of Family and Community Medicine, University of Illinois at Chicago, and colleagues wrote. “However, these studies did not evaluate insurance status as a mediator for more advanced cervical cancer stage at diagnosis between different racial and ethnic groups.”

The study included 23,942 women aged 21 to 64 years (median age, 45 years) who received a cervical cancer diagnosis between January 1, 2007, and December 31, 2016. Using data from the Surveillance, Epidemiology and End Results program, the researchers identified these women to assess the extent that racial and ethnic differences in advanced-stage cervical cancer may be influenced by insurance status. Statistical analysis was performed from February 24, 2022, to January 18, 2023.

More than one-half (52.9%) of the population were White, 24.5% were Hispanic or Latina, 12.9% were Black, 9% were Asian or Pacific Islander, and 0.8% were American Indian or Alaska Native. Nearly 60% of women had private or Medicare insurance, 32.5% received coverage through Medicaid, and 8% were uninsured.

The researchers observed that a lower proportion of Black (41.7%), American Indian or Alaska Native (48.7%), Asian or Pacific Islander (49.9%), and Hispanic or Latina (51.6%) women received a diagnosis of early-stage cervical cancer compared with White women (53.3%; P<.001).

In addition, more White women had private or Medicare insurance at the time of diagnosis (69.4%) compared with women in the other racial and ethnic groups (Black, 48.2%; American Indian or Alaska Native, 48.7%; Asian or Pacific Islander, 64.3%; and Hispanic or Latina, 42.5%; P<.001).

Compared with women who were uninsured or had Medicaid insurance, a larger proportion of women with private or Medicare insurance had an early-stage cervical cancer diagnosis (41.1% vs 57.8%, respectively). In addition, White women were more likely to undergo surgery for early-stage and advanced-stage cervical cancer versus Black women.

In the mediation analysis, the researchers found that lacking health insurance or having Medicaid insurance accounted for racial and ethnic inequities in advanced-stage cervical cancer diagnosis across all racial and ethnic minority groups, with 51.3% for Black women, 52.5% for American Indian or Alaska Native women, 53.8% for Asian or Pacific Islander women, and 55.1% for Hispanic or Latina women compared with White women.

“Health insurance status is a modifiable risk factor that could reduce these persistent cervical cancer mortality inequities among Black individuals,” the researchers wrote. “Extrapolating our results, even among populations that do not possess differences in cervical cancer mortality, far fewer individuals of all races and ethnicities would receive a diagnosis of advanced-stage cancer and, thus, would have a higher 5-year survival rate.”

“Our study found that insurance status mediated more than half of the advanced-stage cervical cancers diagnosed among women from racial and ethnic minority groups. Although our findings suggest that a large proportion of the cancer inequities was associated with insurance status, we also acknowledge that equity in insurance coverage will not eliminate cervical cancer unilaterally,” they concluded.


  1. Holt HK, Peterson CE, MacLaughlan David S, et al. Mediation of racial and ethnic inequities in the diagnosis of advanced-stage cervical cancer by insurance status. JAMA Netw Open. 2023;6:e232985.

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