Titill: | Public health insurance and cancer‐specific mortality risk among patients with breast cancer: A prospective cohort study in China |
Höfundur: |
... 4 fleiri höfundar Sýna alla höfunda |
Útgáfa: | 2020-07-14 |
Tungumál: | Enska |
Umfang: | 28-37 |
Háskóli/Stofnun: | Háskóli Íslands University of Iceland |
Svið: | Heilbrigðisvísindasvið (HÍ) School of Health Sciences (UI) |
Deild: | Læknadeild (HÍ) Faculty of Medicine (UI) |
Birtist í: | International Journal of Cancer;148(1) |
ISSN: | 0020-7136 1097-0215 (eISSN) |
DOI: | 10.1002/ijc.33183 |
Efnisorð: | Cancer Research; Oncology; Breast cancer; Cohort study; Health insurance; Prognosis; Survival; Brjóstakrabbamein; Krabbameinsrannsóknir; Batahorfur |
URI: | https://hdl.handle.net/20.500.11815/2256 |
Tilvitnun:Xie, Y., Valdimarsdóttir, U.A., Wang, C., Zhong, X., Gou, Q., Zheng, H., Deng, L., He, P., Hu, K., Fall, K., Fang, F., Tamimi, R.M., Luo, T., Lu, D., 2021. Public health insurance and cancer‐specific mortality risk among patients with breast cancer: A prospective cohort study in China. International Journal of Cancer. doi:10.1002/ijc.33183
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Útdráttur:Little is known about how health insurance policies, particularly in developing countries, influence breast cancer prognosis. Here, we examined the association between individual health insurance and breast cancer-specific mortality in China. We included 7436 women diagnosed with invasive breast cancer between 2009 and 2016, at West China Hospital, Sichuan University. The health insurance plan of patient was classified as either urban or rural schemes and was also categorized as reimbursement rate (ie, the covered/total charge) below or above the median. Breast cancer-specific mortality was the primary outcome. Using Cox proportional hazards models, we calculated hazard ratios (HRs) for cancer-specific mortality, contrasting rates among patients with a rural insurance scheme or low reimbursement rate to that of those with an urban insurance scheme or high reimbursement rate, respectively. During a median follow-up of 3.1 years, we identified 326 deaths due to breast cancer. Compared to patients covered by urban insurance schemes, patients covered by rural insurance schemes had a 29% increased cancer-specific mortality (95% CI 0%-65%) after adjusting for demographics, tumor characteristics and treatment modes. Reimbursement rate below the median was associated with a 42% increased rate of cancer-specific mortality (95% CI 11%-82%). Every 10% increase in the reimbursement rate is associated with a 7% (95% CI 2%-12%) reduction in cancer-specific mortality risk, particularly in patients covered by rural insurance schemes (26%, 95% CI 9%-39%). Our findings suggest that underinsured patients face a higher risk of breast cancer-specific mortality in developing countries.
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Athugasemdir:We thank all staff members working on the Breast Cancer Information Management System (BCIMS) for their contributions to data collection and management. We also thank Dr Bo Fu, Mr Yan Li and Mr Pei Liu at the University of Electronic Science and Technology of China for data cleaning and zip code mapping. Our study was supported by the Key Research and Development Project of Sichuan Province of China (grant number: 2017SZ00005) and Swedish Research Council (grant number: 2018‐00648).
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Leyfi:This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,provided the original work is properly cited.
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