Effect of insurance status on mortality following surgical treatment of colorectal cancers in the United States

Why Health Coverage Can Be a Matter of Life and Death

For many Americans, health insurance feels like a financial decision. This study asks a more unsettling question: when someone needs major surgery for colon cancer, does their type of insurance change their chances of surviving the hospital stay? By sifting through records from hundreds of thousands of patients across the United States, the researchers show that lacking insurance is not just a paperwork issue—it is closely tied to whether people make it home after life‑saving cancer surgery.

Looking at Cancer Surgery Across the Country

To explore this question, the authors turned to a massive national hospital database that tracks millions of stays each year. They focused on adults aged 18 to 65 who were admitted between 2005 and 2014 with colon cancer and underwent removal of part of their large intestine, a procedure called a colectomy. Patients were grouped based on their coverage: private insurance, Medicaid (government coverage for people with low income), or no insurance at all. The team then compared how often patients in each group died before discharge, while also taking into account age, sex, income level, hospital type, cancer stage, and surgical complications.

Who These Patients Were

The study included 301,304 hospitalizations, providing a broad snapshot of colon cancer care in the United States. About four out of five patients had private insurance, one in eight were covered by Medicaid, and roughly one in thirteen had no insurance. Most were between 45 and 65 years old, slightly more than half were men, and more than half were treated in large, urban teaching hospitals that handle many complex cancer cases. Over a third had cancers that had already spread to lymph nodes or beyond, and the vast majority underwent traditional open surgery rather than minimally invasive approaches, reflecting practice patterns during the study years.

Insurance and the Risk of Dying in the Hospital

When the researchers looked at deaths during the hospital stay, the differences between groups were striking. Among privately insured patients, fewer than 1 in 100 died after surgery. For those covered by Medicaid, that figure was about 1.5 in 100, and for the uninsured it was roughly 2 in 100—three times the rate seen with private insurance. Even after adjusting for many factors that might influence risk, such as cancer stage, other illnesses, hospital characteristics, and the occurrence of complications, uninsured patients still faced a 60% higher risk of dying in the hospital than those with private coverage. Medicaid patients, by contrast, did not have a significantly different risk from privately insured patients once these differences were taken into account.

Digging Deeper Into Patient Health and Hospital Type

One possibility is that uninsured patients are simply sicker to begin with. To test this, the authors repeated their analysis in a smaller group of patients who had relatively few other medical problems. Even in this healthier subset, uninsured patients were more than twice as likely to die in the hospital as similar patients with private insurance. The gap was especially pronounced in urban teaching hospitals, which usually offer advanced cancer care; within these centers, uninsured patients again showed more than double the risk of in‑hospital death. These patterns suggest that factors beyond measurable illness—such as delays in seeking care, emergency presentations, or differences in the intensity or quality of treatment—may be driving the survival gap.

What This Means for Patients and Policy

To a non‑specialist, the message is clear: when it comes to surviving major colon cancer surgery, having no insurance is dangerous in itself. The higher death rates among uninsured patients persisted even after accounting for how advanced their cancer was, how sick they appeared on paper, and where they were treated. While the study cannot directly measure every step of care, it underscores that financial barriers can translate into later diagnoses, fewer options, and worse outcomes. Policies that expand and stabilize health coverage are therefore not only about reducing bills—they may literally help save lives for people facing one of the most common and deadly cancers.

Citation: Khosla, A.A., Singh, A., Rubens, M. et al. Effect of insurance status on mortality following surgical treatment of colorectal cancers in the United States. Sci Rep 16, 10643 (2026). https://doi.org/10.1038/s41598-025-21334-6

Keywords: colorectal cancer, health insurance, surgical outcomes, health disparities, hospital mortality