Effects of health insurance and race on early detection of cancer
Effects of health insurance and race on early detection of cancer
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DOI：
10.1093/jnci/91.16.1409
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发表时间：
1999-08-18
影响因子：
10.3
通讯作者：
Krischer, JP
中科院分区：
文献类型：
--
作者：
Roetzheim, RG;Pal, N;Krischer, JP
背景：健康保险的存在和类型可能是癌症诊断阶段的重要决定因素。为了确定以前观察到的癌症诊断时的分期种族差异是否可以部分地用保险覆盖范围的差异来解释，我们研究了1994年在佛罗里达发生黑色素瘤或结直肠癌、乳腺癌或前列腺癌的所有患者，这些患者的诊断时的分期和保险状况是已知的。研究方法：通过调整个体的年龄、性别、婚姻状况、教育、收入和合并症，检查了保险和种族对晚期（区域或远处）诊断几率的影响。所有P值均为双侧。结果：共分析了28237例患者的数据。未投保的人比有商业赔偿保险的人更有可能在晚期被诊断出（结直肠癌比值比[OR] = 1.67，P = 0.004;黑色素瘤OR 2.59，P = 0.004;乳腺癌VK 1.43，P = 0.001;前列腺癌OR = 1.47，P = 0.02）。医疗补助保险的患者更有可能在晚期乳腺癌（OR = 1.87，P <0.001）和黑色素瘤（OR = 4.69，P <0.001）诊断。非西班牙裔非洲裔美国人患者比非西班牙裔白人更有可能被诊断为晚期乳腺癌和前列腺癌。西班牙裔患者更有可能被诊断为晚期乳腺癌，但不太可能被诊断为晚期前列腺癌，结论：缺乏医疗保险的人和医疗补助保险的人更有可能被诊断为晚期癌症在不同的网站，并努力改善这些群体获得癌症筛查服务是必要的。在诊断阶段的种族差异不能用保险范围或社会经济地位来解释。
Background: The presence and type of health insurance may be an important determinant of cancer stage at diagnosis. To determine whether previously observed racial differences in stage of cancer at diagnosis may be explained partly by differences in insurance coverage, we studied all patients with incident cases of melanoma or colorectal, breast, or prostate cancer in Florida in 1994 for whom the stage at diagnosis and insurance status were known. Methods: The effects of insurance and race on the odds of a late stage (regional or distant) diagnosis were examined by adjusting for an individual's age, sex, marital status, education, income, and comorbidity, All P values are two-sided. Results: Data from 28237 patients were analyzed. Persons who were uninsured were more likely diagnosed at a late stage (colorectal cancer odds ratio [OR] = 1.67, P = .004; melanoma OR 2.59, P = .004; breast cancer VK 1.43, P = .001; prostate cancer OR = 1.47, P = .02) than were persons,vith commercial indemnity insurance. Patients insured by Medicaid were more likely diagnosed at a late stage of breast cancer (OR = 1.87, P < .001) and melanoma (OR = 4.69, P < .001). Non-Hispanic African-American patients were more likely diagnosed with late stage breast and prostate cancers than were non-Hispanic whites. Hispanic patients were more likely to be diagnosed with late stage breast cancer but less likely to be diagnosed with late stage prostate cancer, Conclusions: Persons lacking health insurance and persons insured by Medicaid are more likely diagnosed with late stage cancer at diverse sites, and efforts to improve access to cancer-screening services are warranted for these groups. Racial differences in stage at diagnosis are not explained by insurance coverage or socioeconomic status.