Survival inequity in vulnerable populations with early-stage hepatocellular carcinoma: a United States safety-net collaborative analysis.
Survival inequity in vulnerable populations with early-stage hepatocellular carcinoma: a United States safety-net collaborative analysis.
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DOI：
10.1016/j.hpb.2020.11.1150
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Goel N
中科院分区：
文献类型：
--
作者：
Kronenfeld JP;Ryon EL;Goldberg D;Lee RM;Yopp A;Wang A;Lee AY;Luu S;Hsu C;Silberfein E;Russell MC;Merchant NB;Goel N
获得健康保险和治疗干预措施[手术/肝脏定向治疗（LDT）]会影响早期肝细胞癌（HCC）的生存率。这项对高容量安全网医院（SNH）及其第三学术中心（AC）的多机构研究的目的是确定保险类型/缺乏对医院之间生存差异的影响，特别是SNH，其使命是最大限度地减少弱势人群获得与保险相关的护理障碍。来自美国安全网协作组织的早期HCC患者（2012-2014年）在SNH/AC的治疗中与倾向评分匹配。总生存期（OS）是主要结局。进行多变量考克斯比例风险分析，解释社会人口统计学和临床参数。在925例患者中，与有政府保险（GI）和私人保险的患者相比，无保险（NI）患者的根治性手术减少[PI，（PI-SNH：60.5% vs. GI-SNH：33.1% vs. NI-SNH：13.6%，p<0.001]，中位OS减少（PI-SNH：32.1 vs. GI-SNH：22.8 vs. NI-SNH：9.4个月，p=0.002）。在控制社会人口统计学/临床参数的多变量回归分析中，NI-SNH（HR：2.5，95%CI：1.3-4.9，p=0.007）是唯一OS显著更差的保险类型/医院系统组合。NI-SNH患者接受的治愈性治疗少于其他保险/医院类型，这表明除获得护理外，还需要识别和解决治疗障碍，以实现弱势人群（NI-SNH）早期HCC的生存公平性。
Access to health insurance and curative interventions [surgery/liver directed therapy (LDT)] affects survival for early-stage hepatocellular carcinoma (HCC). The aim of this multi-institutional study of high-volume safety-net hospitals (SNHs) and their tertiary-academic-centers (AC) was to identify the impact of type/lack of insurance on survival disparities across hospitals, particularly SNHs whose mission is to minimize insurance related access to care barriers for vulnerable populations. Early-stage HCC patients (2012-2014) from the US Safety-Net Collaborative were propensity-score matched by treatment at SNH/AC. Overall survival (OS) was the primary outcome. Multivariable Cox proportional-hazard analysis was performed accounting for sociodemographic and clinical parameters. Among 925 patients, those with no insurance (NI) had decreased curative surgery, compared to those with government insurance (GI) and private insurance [PI, (PI-SNH:60.5% vs. GI-SNH:33.1% vs. NI-SNH:13.6%, p<0.001], and decreased median OS (PI-SNH:32.1 vs. GI-SNH:22.8 vs. NI-SNH:9.4 months, p=0.002). On multivariable regression controlling for sociodemographic/clinical parameters, NI-SNH (HR:2.5, 95% CI:1.3-4.9, p=0.007) was the only insurance type/hospital system combination with significantly worse OS. NI-SNH patients received less curative treatment than other insurance/hospitals types suggesting that treatment barriers, beyond access to care, need to be identified and addressed to achieve survival equity in early-stage HCC for vulnerable populations (NI-SNH).
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影响因子：
--
作者：
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通讯作者：
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DOI：
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发表时间：
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影响因子：
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