Campbell D, Gorey KM, Luginaah IN, Zou G, Hamm C, Holowaty EJ. Gender differences on the interacting effects of marital status and health insurance on long-term colon cancer survival in California, 1995-2014.
Public Health 2016;
140:258-260. [PMID:
27506641 PMCID:
PMC5118043 DOI:
10.1016/j.puhe.2016.07.008]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Abstract
Objectives
Long-term colon cancer survival is not well explained by main effects. We explored the interaction of age, gender, marital status, health insurance and poverty on 10-year colon cancer survival.
Methods
California registry data were analyzed for 5,776 people diagnosed from 1995 to 2000; followed until 2014. Census data classified neighborhood poverty. We tested interactions with regressions and described them with standardized rates and rate ratios (RR).
Results
The 5-way interaction was significant, suggesting larger 4-way disadvantages among non-Medicare-eligible people. A significant 4-way interaction was a 3-way interaction in non-high poverty neighborhoods only. Private insurance was protective for unmarried men (RR = 1.60) but not women, while it was protective for married women (RR = 1.22) but not men. This pattern seemed explained by lower-incomes of certain groups of unmarried women and married men and more prevalent underinsuring of unmarried men.
Conclusions
Structural inequities related to the institutions of marriage and health care seem to affect women and men quite differently. Policy makers ought to be cognizant of such structural imbalances as future reforms of American health care are considered.
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