Insurance status and distant-stage disease at diagnosis among adolescent and young adult patients with cancer aged 15 to 39 years: National Cancer Data Base, 2004 through 2010
Insurance status and distant-stage disease at diagnosis among adolescent and young adult patients with cancer aged 15 to 39 years: National Cancer Data Base, 2004 through 2010
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DOI：
10.1002/cncr.28568
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发表时间：
2014-04-15
期刊：
影响因子：
6.2
通讯作者：
Barr, Ronald D.
中科院分区：
文献类型：
--
作者：
Robbins, Anthony S.;Lerro, Catherine C.;Barr, Ronald D.
在1975年至2004年期间，青少年和年轻成人（AYA）癌症患者（年龄在15-39岁之间）在疾病的远端阶段诊断的百分比没有显着变化。据推测，缺乏健康保险可能是AYA患者诊断为远端疾病的一个重要风险因素，但据作者所知，这尚未在全国样本中进行检查。用于获得2004年至2010年期间诊断的15岁至39岁患者的癌症病例数据。在所有排除后，共有285，448例病例可用于分析;所有AYA癌症部位均包括在内。进行了一项回顾性研究，以评估保险状况与诊断时疾病阶段之间的关联。在调整年龄、种族/民族、设施类型、基于邮政编码的收入和教育水平以及美国人口普查地区后，发现在男性中，与有私人保险的患者相比，无保险的患者在疾病早期被诊断出的可能性高出1.51倍（95%置信区间，1.46-1.55）。在女性中，保险的影响更强，未投保的患者在遥远阶段被诊断的可能性高出1.86倍（95%置信区间，1.79-1.94）。保险状况对更容易早期发现的恶性肿瘤的影响更大（黑色素瘤、甲状腺癌、乳腺癌、泌尿生殖系统癌），而那些不太容易早期发现的肿瘤则明显较弱（肺癌、肾上腺皮质癌、肾母细胞瘤）。结论在全国大样本的AYA癌症患者中，保险状况被认为是一个强大的独立的风险因素远阶段的疾病在诊断时。Cancer 2014;120：1212-1219. (c)2014年美国癌症协会
BACKGROUNDThe percentage of adolescent and young adult (AYA) patients with cancer (those aged 15-39 years) diagnosed at a distant stage of disease did not significantly change between 1975 and 2004. It has been hypothesized that a lack of health insurance may be a significant risk factor for a diagnosis of distant-stage disease among AYA patients, but to the authors' knowledge this has not been examined in a national sample.METHODSThe National Cancer Data Base, a hospital-based cancer registry, was used to obtain data regarding incident cancer cases among patients aged 15 years to 39 years who were diagnosed between 2004 and 2010. After all exclusions, a total of 285,448 cases were available for analysis; all AYA cancer sites were included. A retrospective study was conducted to assess the association between insurance status and stage of disease at diagnosis.RESULTSAfter adjusting for age, race/ethnicity, facility type, ZIP code-based income and education levels, and US Census region, it was found that among males, uninsured patients were 1.51 times more likely to be diagnosed at a distant stage of disease compared with patients with private insurance (95% confidence interval, 1.46-1.55). Among females, the effect of insurance was stronger, with uninsured patients found to be 1.86 times more likely to be diagnosed at a distant stage (95% confidence interval, 1.79-1.94). The effect of insurance status was substantially stronger for malignancies that are more amenable to early detection (melanoma, thyroid carcinoma, breast carcinoma, genitourinary carcinoma), and substantially weaker for those that are less amenable to early detection (lung carcinoma, adrenocortical carcinoma, Wilms tumor).CONCLUSIONSIn a large national sample of AYA patients with cancer, insurance status was found to be a strong independent risk factor for distant-stage disease at the time of diagnosis. Cancer 2014;120:1212-1219. (c) 2014 American Cancer Society.