Cost disparities in lung cancer treatment by disability status, sex, and race
Cost disparities in lung cancer treatment by disability status, sex, and race
复制标题
DOI：
10.1016/j.dhjo.2008.01.004
复制
发表时间：
2008-04-01
影响因子：
4.5
通讯作者：
Iezzoni, Lisa I.
中科院分区：
文献类型：
--
作者：
Chirikos, Thomas N.;Roetzheim, Richard G.;Iezzoni, Lisa I.
背景：最近的文献中有大量关于肺癌的诊断、治疗和结果在越来越多的人群亚组中存在差异的报告，包括残疾状况。一个常见的假设是，差异主要源于特定亚群体可获得的治疗资源水平和类型的差异。然而，很少有研究直接测量资源差异。由于政策制定者将减少健康差异视为首要任务，因此本研究研究了按残疾状况、性别和种族定义的八个患者亚组中肺癌治疗的累积医疗保险费用（资源消耗）是否存在差异。假设：在控制其他可能的成本驱动因素的情况下，这八个亚组的治疗差异将反映在这些亚组的累积成本概况的变化中。未能检测到这些成本概况中的统计显着差异意味着治疗差异源于医疗保健服务的获取和利用以外的其他因素。方法：使用关联的 SEER-Medicare 数据，按服务类型和治疗阶段构建约 80,000 例诊断时年龄为 45 至 85 岁的肺癌病例的成本概况。然后，多元回归模型测试了八个亚组之间的成本差异，控制了各种患者和疾病特征。结果：发现了显着的成本差异，其中一些是意料之外的。女性的治疗费用往往高于男性；他们的生存状况也更好。非白人的治疗费用也往往比白人高，尽管他们的生存期明显较短。平均而言，残疾男性消耗的治疗资源最少，生存期也最短。残疾妇女的结果好坏参半。结论：除其他外，调查结果表明，减少差距不仅仅需要改善获得医疗保健的机会。政策制定者和临床医生都必须特别关注残疾肺癌患者。 (C) 2008 Elsevier Inc. 保留所有权利。
Background: The recent literature contains numerous reports of disparities in the diagnosis, treatment, and outcomes of lung cancer across a growing list of population subgroups, including disability status. A common assumption is that disparities stem mainly from variations in the level and type of treatment resources available to specific subgroups. Few studies, however, have directly measured resource differentials. Since policy makers identify reducing health disparities as a critical priority, this study examined whether cumulative Medicare costs (resource consumption) for lung cancer treatment differ across eight patient subgroups defined by disability status, sex, and race.Hypothesis: Treatment disparities across the eight subgroups will be reflected in variations in the cumulative cost profiles of those subgroups, controlling for other plausible cost drivers. Failure to detect statistically significant differentials in these cost profiles implies that treatment disparities stem from factors other than access to, and utilization of, health care services.Methods: Linked SEER-Medicare data were used to construct cost profiles by service type and treatment phase for roughly 80,000 incident lung cancer cases in patients aged 45 to 85 years at diagnosis. Multiple regression models then tested for cost differentials across the eight subgroups, controlling for various patient and disease characteristics.Results: Significant cost differentials were detected, some unanticipated. Women tended to have higher treatment costs than men; they also had more favorable survivals. Nonwhites also tended to have higher treatment costs than whites, although they had significantly shorter survivals. On average, men with disabilities consumed the fewest treatment resources and had the shortest survivals. Mixed results were obtained for women with disabilities.Conclusions: Among others, the findings suggest that reducing disparities will take more than just improving access to health care. Special attention must be paid to lung cancer patients with disabilities by both policy makers and clinicians. (C) 2008 Elsevier Inc. All rights reserved.