Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer
Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer
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DOI：
10.1200/jco.2015.64.6620
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发表时间：
2016-03-20
影响因子：
45.3
通讯作者：
Newcomb, Polly
中科院分区：
文献类型：
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作者：
Ramsey, Scott D.;Bansal, Aasthaa;Newcomb, Polly
癌症患者比一般人群更有可能申请破产，但严重的财务困境对癌症患者健康结果的影响尚不清楚。方法：我们将西华盛顿SEER癌症登记记录与该地区的联邦破产记录联系起来。通过使用倾向评分匹配来解释有和没有申请破产的患者之间的几种人口统计学和临床因素的差异，然后我们拟合Cox比例风险模型来检验破产申请与生存之间的关系。结果1995年至2009年间，231596人被诊断患有癌症。申请破产的患者（n = 4728）更可能是年轻、女性和非白人，在诊断时患有局部或区域（v远端）期疾病，并接受过治疗。倾向评分匹配后，每组仍有3841例患者（破产vs不破产）。在匹配的样本中，平均年龄为53.0岁，54%为男性，平均收入为49,000美元，大多数是白人（86%），已婚（60%）和城市（91%），诊断时患有局部或区域阶段的疾病（84%）。两组都接受了类似的初始治疗。申请破产的癌症患者与未申请破产的癌症患者的调整死亡率风险比为1.79 （95% CI, 1.64 - 1.96）。风险比因癌症类型而异：结直肠癌、前列腺癌和甲状腺癌的风险比最高。从模型中排除晚期疾病患者对结果没有影响。结论癌症诊断后需要破产保护的严重经济困难可能是死亡的危险因素。需要进一步的研究来了解癌症诊断后极端经济困难影响生存的过程，并找到可以减轻这种风险的策略。
Purpose Patients with cancer are more likely to file for bankruptcy than the general population, but the impact of severe financial distress on health outcomes among patients with cancer is not known.Methods We linked Western Washington SEER Cancer Registry records with federal bankruptcy records for the region. By using propensity score matching to account for differences in several demographic and clinical factors between patients who did and did not file for bankruptcy, we then fit Cox proportional hazards models to examine the relationship between bankruptcy filing and survival.Results Between 1995 and 2009, 231,596 persons were diagnosed with cancer. Patients who filed for bankruptcy (n = 4,728) were more likely to be younger, female, and nonwhite, to have local-or regional-(v distant-) stage disease at diagnosis, and have received treatment. After propensity score matching, 3,841 patients remained in each group (bankruptcy v no bankruptcy). In the matched sample, mean age was 53.0 years, 54% were men, mean income was $49,000, and majorities were white (86%), married (60%), and urban (91%) and had local-or regional-stage disease at diagnosis (84%). Both groups received similar initial treatments. The adjusted hazard ratio for mortality among patients with cancer who filed for bankruptcy versus those who did not was 1.79 (95% CI, 1.64 to 1.96). Hazard ratios varied by cancer type: colorectal, prostate, and thyroid cancers had the highest hazard ratios. Excluding patients with distant-stage disease from the models did not have an effect on results.Conclusion Severe financial distress requiring bankruptcy protection after cancer diagnosis appears to be a risk factor for mortality. Further research is needed to understand the process by which extreme financial distress influences survival after cancer diagnosis and to find strategies that could mitigate this risk.