Macroeconomic environment and insurance-mortality relationship: An analysis of gender-based disparity among non-elderly adult patients of melanoma and lung cancer
Macroeconomic environment and insurance-mortality relationship: An analysis of gender-based disparity among non-elderly adult patients of melanoma and lung cancer
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DOI：
10.1111/ecc.13229
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发表时间：
2020
影响因子：
2.1
通讯作者：
Li Kang
中科院分区：
文献类型：
--
作者：
Adnan Humara;Adnan Sheikh Muhammad;Deng Kui;Yang Chunyan;Hou Yan;Nkondjock Victorine Raissa Ngo;Li Kang
Objective Cancer patients exhibit disparity in mortality risks across demographic divisions as well as insurance groups. The effects of macroeconomic environment also vary for such strata. This study analyses the gaps between mortality risks for male and female cancer patients with and without insurance and examines how such gaps transform over time with macroeconomic shifts. Methods Demographic, clinical and treatment records of 45,750 melanoma and 91,157 lung cancer patients diagnosed in 2007-2009 and 2011-2013 were extracted from Surveillance, Epidemiology and End Results (SEER) database. Kaplan-Meier test was applied to ascertain survival probability of each insurance group, while Cox proportional hazard model was used to assess relative mortality risk for Medicaid and uninsured patients, for the whole data as well as separately for both time periods and genders. Results Both the hazard ratios and change thereof over time are greater for female patients without insurance, than for male patients. More than any insurance-gender subgroup, uninsured female patients of melanoma have much increased hazard ratios, from 1.41 [95% confidence interval (CI), 1.04-1.92] to 2.22 [95% CI, 1.67-2.94]. Conclusion Despite diagnostic improvements and technology advancements, the adverse effects of macroeconomic crisis are associated with increased relative mortality risks for cancer patients without insurance, more for women than men.
