Household disposable income and long-term survival after pulmonary resections for lung cancer
Household disposable income and long-term survival after pulmonary resections for lung cancer
复制标题
家庭可支配收入与肺癌肺切除术后的长期生存
作者：
Erik Sachs;Veronica Jackson;U. Sartipy
社会经济差异与肺癌患者的生存差异有关。瑞典的医疗保健是由税收资助的，并提供平等的护理机会，因此，肺癌手术后的生存应该与家庭收入无关。这项研究的目的是调查瑞典家庭可支配收入与肺癌手术后生存率之间的关系。方法我们进行了一项全国范围内基于人群的队列研究，包括2008-2017年在瑞典接受肺癌肺切除术的所有患者。在国家质量和健康数据登记册之间建立个人记录联系，以获取有关社会经济地位和病史的信息。采用家庭可支配收入五分位数的考克斯回归来估计调整后的全因死亡风险。结果：我们纳入了5500例患者，在最低和最高收入的五分之一人群中，年龄校正和性别校正的死亡发生率分别为15和9.4/100人年（平均随访时间为3.2年）。与收入较高的患者相比，贫困患者年龄较大，有更多的合并症，并且不太可能进行术前正电子发射断层扫描或微创手术。最高收入五分位数与最低收入五分位数相比，调整后的死亡风险比为0.77（95%CI：0.62至0.96）。结论：我们发现，尽管有税收资助的全民健康保险，但在瑞典接受肺癌手术的患者中，家庭可支配收入与生存率之间存在关联。在调整基线特征差异后，这种关联仍然存在。
Introduction Socioeconomic disparities have been linked to survival differences in patients with lung cancer. Swedish healthcare is tax-funded and provides equal access to care, therefore, survival following lung cancer surgery should be unrelated to household income. The aim of this study was to investigate the association between household disposable income and survival following surgery for lung cancer in Sweden. Methods We conducted a nationwide population-based cohort study including all patients who underwent pulmonary resections for lung cancer in Sweden 2008–2017. Individual-level record linkages between national quality and health-data registers were performed to acquire information regarding socioeconomic status and medical history. Cox regression by quintiles of household disposable income was used to estimate the adjusted risk for all-cause mortality. Results We included 5500 patients and the age-adjusted and sex-adjusted incidence rate of death per 100 person-years was 15 and 9.4 in the lowest and highest income quintile, respectively (mean follow-up time 3.2 years). Deprived patients were older, had more comorbidities and were less likely to have preoperative positron emission tomography or minimally invasive surgery, compared with patients with higher income. The adjusted HR for death was 0.77 (95% CI: 0.62 to 0.96) for the highest income quintile compared with the lowest. Conclusions We found an association between household disposable income and survival in patients who underwent surgery for lung cancer in Sweden, despite tax-funded universal health coverage. The association remained after adjustment for differences in baseline characteristics.