THE RELATION BETWEEN HEALTH-INSURANCE COVERAGE AND CLINICAL OUTCOMES AMONG WOMEN WITH BREAST-CANCER
THE RELATION BETWEEN HEALTH-INSURANCE COVERAGE AND CLINICAL OUTCOMES AMONG WOMEN WITH BREAST-CANCER
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DOI：
10.1056/nejm199307293290507
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发表时间：
1993-07-29
影响因子：
158.5
通讯作者：
EPSTEIN, AM
中科院分区：
文献类型：
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作者：
AYANIAN, JZ;KOHLER, BA;EPSTEIN, AM
背景没有私人医疗保险的妇女比有私人保险的妇女更不可能接受乳腺癌筛查，而且在癌症确诊后，她们的治疗可能会有所不同。在这项研究中，我们解决了两个相关的问题：没有保险的患者和医疗补助覆盖的患者在疾病最初诊断时比私人保险的患者患上更晚期的乳腺癌吗？而且，对于疾病的每个阶段，没有保险的病人和医疗补助覆盖的病人在乳腺癌诊断后比私人保险的病人死得更早吗？方法.我们研究了4675名年龄在35 - 64岁之间的妇女，她们在1985 - 1987年被诊断为浸润性乳腺癌，通过将新泽西州癌症登记处的记录与出院数据联系起来。我们比较了到1992年6月，有私人保险、无保险和医疗补助的妇女的疾病阶段和特定阶段的生存率。我们还估计了这些人群的调整后死亡风险，使用比例风险回归分析来控制年龄、种族、婚姻状况、家庭收入、共存诊断和疾病分期。没有保险的病人和那些有医疗补助的病人比有私人保险的病人有更严重的疾病（P
Background. Women without private health insurance are less likely than privately insured women to be screened for breast cancer, and their treatment may differ after cancer is diagnosed. In this study we addressed two related questions: Do uninsured patients and those covered by Medicaid have more advanced breast cancer than privately insured patients when the disease is initially diagnosed? And, for each stage of disease, do uninsured patients and patients covered by Medicaid die sooner after breast cancer is diagnosed than privately insured patients?Methods. We studied 4675 women, 35 to 64 years of age, in whom invasive breast cancer was diagnosed from 1985 through 1987, by linking New Jersey State Cancer Registry records to hospital-discharge data. We compared the stage of disease and stage-specific survival among women with private insurance, no insurance, and Medicaid coverage through June 1992. We also estimated the adjusted risk of death for these groups, using proportional-hazards regression analysis to control for age, race, marital status, household income, coexisting diagnoses, and disease stage.Results. Uninsured patients and those covered by Medicaid presented with more advanced disease than did privately insured patients (P