Enrollment in a universal health care system was associated with a lower risk of all-cause mortality among patients with colon cancer in a study published in Cancer Epidemiology, Biomarkers, & Prevention.

Researchers compared colon cancer patients from the general population with colon cancer patients who received universal health care via the US military health system (MHS).

The MHS allows beneficiaries to receive care free of charge or with minimal out-of-pocket costs. The patients from the general population could have private insurance, Medicaid, or no insurance.

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The study included data from 11,907 MHS patients enrolled in the Department of Defense Automated Central Tumor Registry (ACTUR) and 23,814 matched patients from the general population enrolled in the Surveillance, Epidemiology, and End Results (SEER) program.

All patients were diagnosed with colon adenocarcinoma from 1987 through 2013. The  median follow-up was 56 months for the ACTUR cohort and 49 months for the SEER cohort.

The ACTUR cohort had an 18% lower risk of all-cause mortality compared with the SEER cohort (hazard ratio [HR], 0.82; 95% CI, 0.79-0.87).

The lower risk of death in the ACTUR cohort was consistent across most subgroups, including among Black patients (HR, 0.74; 95% CI, 0.64-0.85) and White patients (HR, 0.82; 95% CI, 0.77-0.87).

“The tendency of more survival benefit among Blacks than Whites may suggest the potential impact of universal health care on the reduction of racial disparity in survival among colon cancer patients,” the study authors wrote.

The authors also found that patients in the ACTUR cohort were significantly less likely to have stage III or IV disease at diagnosis (prevalence ratio, 0.90; 95% CI, 0.85-0.94).

Furthermore, the ACTUR cohort had significantly better survival than the SEER cohort for all tumor stages except unknown stage.

“MHS beneficiaries with colon cancer had better survival than their counterparts in the general population,” the authors wrote. “Future studies are warranted to identify factors contributing to the improved survival.”


Lin J, McGlynn KA, Shriver CD, Zhu K. Comparison of survival among colon cancer patients in the U.S. military health system and patients in the Surveillance, Epidemiology, and End Results (SEER) program. Cancer Epidemiol Biomark Prev. Published online June 23, 2021. doi:10.1158/1055-9965.EPI-20-1267