Association of Medical Financial Hardship and Mortality Among Cancer Survivors in the United States
Association of Medical Financial Hardship and Mortality Among Cancer Survivors in the United States
复制标题
DOI：
10.1093/jnci/djac044
复制
发表时间：
2022-04-20
影响因子：
10.3
通讯作者：
Zheng, Zhiyuan
中科院分区：
文献类型：
--
作者：
Yabroff, K. Robin;Han, Xuesong;Zheng, Zhiyuan
在美国，癌症幸存者经常经历医疗经济困难。然而，人们对长期健康后果知之甚少。本研究在一个具有全国代表性的大型癌症幸存者样本中考察了经济困难和死亡率之间的关系。方法我们从1997-2014年全国健康访谈调查中确定了18-64岁（n = 14 917）和65-79岁（n = 10 391）的癌症幸存者，并将其与截至2015年12月31日的生命状态相关的死亡率文件联系起来。医疗经济困难是衡量在过去12个月内由于费用而无法提供护理或延迟或放弃任何护理的问题。死亡率的风险估计与单独的加权考克斯比例风险模型的年龄组，年龄作为时间尺度，控制的社会人口特征的影响。健康保险覆盖范围依次添加到多变量模型中。结果在18-64岁和65-79岁的癌症幸存者中，分别有29.6%和11.0%的人报告在过去12个月内有经济困难。在两个年龄组中，生活困难的幸存者的调整后死亡风险均高于其同行：18-64岁（风险比[HR] = 1.17，95%置信区间[CI] = 1.04至1.30）和65-79岁（HR = 1.14，95% CI = 1.02至1.28）。健康保险的进一步调整降低了18-64岁幸存者的困难和死亡率的关联程度（HR = 1.09，95%CI = 0.97至1.24）。调整补充医疗保险覆盖范围对65-79岁的幸存者影响不大（HR = 1.15，95%CI = 1.02至1.29）。结论：医疗经济困难与美国癌症幸存者的死亡风险相关。
Background Cancer survivors frequently experience medical financial hardship in the United States. Little is known, however, about long-term health consequences. This study examines the associations of financial hardship and mortality in a large nationally representative sample of cancer survivors. Methods We identified cancer survivors aged 18-64 years (n = 14 917) and 65-79 years (n = 10 391) from the 1997-2014 National Health Interview Survey and its linked mortality files with vital status through December 31, 2015. Medical financial hardship was measured as problems affording care or delaying or forgoing any care because of cost in the past 12 months. Risk of mortality was estimated with separate weighted Cox proportional hazards models by age group with age as the timescale, controlling for the effects of sociodemographic characteristics. Health insurance coverage was added sequentially to multivariable models. Results Among cancer survivors aged 18-64 years and 65-79 years, 29.6% and 11.0%, respectively, reported financial hardship in the past 12 months. Survivors with hardship had higher adjusted mortality risk than their counterparts in both age groups: 18-64 years (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.04 to 1.30) and 65-79 years (HR = 1.14, 95% CI = 1.02 to 1.28). Further adjustment for health insurance reduced the magnitude of association of hardship and mortality among survivors aged 18-64 years (HR = 1.09, 95% CI = 0.97 to 1.24). Adjustment for supplemental Medicare coverage had little effect among survivors aged 65-79 years (HR = 1.15, 95% CI = 1.02 to 1.29). Conclusion Medical financial hardship was associated with mortality risk among cancer survivors in the United States.