Outcomes of Breast Cancer in Brazil Related to Health Care Coverage: A Retrospective Cohort Study
Outcomes of Breast Cancer in Brazil Related to Health Care Coverage: A Retrospective Cohort Study
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DOI：
10.1158/1055-9965.epi-13-0693
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发表时间：
2014-01-01
影响因子：
3.8
通讯作者：
Goss, Paul E.
中科院分区：
文献类型：
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作者：
Liedke, Pedro E. R.;Finkelstein, Dianne M.;Goss, Paul E.
背景：乳腺癌是巴西女性最常见的恶性肿瘤。公共医疗保健覆盖患者与私人医疗保健覆盖患者在一般特征、疾病表现、原发性肿瘤治疗和临床结果方面的差异尚未得到充分调查。方法：从巴西医疗中心的代表性样本中抽取了 3,142 名患者组成的全国回顾性队列。通过图表审查检索临床和人口统计数据以及医疗保健覆盖类型。使用 x(2) 检验对组进行比较。对数秩检验用于比较无病生存期（DFS）、复发后和总生存期（OS）。进行了多变量 Cox 回归模型，并根据患者特征和诊断阶段进行了调整。所有 P 值都是两侧的。结果：具有公共卫生保险的患者在诊断时患有更晚期的疾病（P < 0.001）。 0-II 期疾病患者的 DFS 和 OS 没有根据医疗保健覆盖类型的不同而有所不同，而 III-IV 期患者的结果存在显着差异（分别为 P = 0.002 和 P = 0.008）。在 Cox 多变量分析中，未发现健康保险类型与 DFS 或 OS 存在关联，但与复发后生存存在关联 (P < 0.001)。结论：在巴西，享受公共健康保险的乳腺癌患者病情更严重，这可能解释了与私人保险的患者相比，DFS 和 OS 更差的原因。影响：早期诊断和治疗乳腺癌可以改善巴西享受公共健康保险的女性的预后。 (C)2013 AACR。
Background: Breast cancer is the most common malignancy in women in Brazil. Differences between patients with public versus private healthcare coverage about general characteristics, disease presentation, treatment of primary tumors, and clinical outcomes have not been fully investigated.Methods: A national, retrospective cohort of 3,142 patients drawn from a representative sample of Brazilian medical centers was selected. Clinical and demographic data and type of healthcare coverage were retrieved by chart review. Groups were compared using the x(2) test. The log-rank test was used for comparison of disease-free survival (DFS), postrelapse, and overall survival (OS). Multivariate Cox regression modeling with adjustment for patient characteristics and stage at diagnosis was performed. All P values are two sided.Results: Patients with public health coverage presented with more advanced disease at diagnosis (P < 0.001). DFS and OS for patients presenting with stage 0-II disease did not differ according to the type of healthcare coverage, whereas a significant difference in outcomes was seen for stage III-IV patients (P = 0.002 and P = 0.008, respectively). In a Cox multivariate analysis, no association was found for the type of health coverage with either DFS or OS, but there was an association for postrelapse survival (P < 0.001).Conclusion: In Brazil, patients with breast cancer with public health coverage present with more advanced disease, and this possibly explains worse DFS and OS when compared with those with private coverage.Impact: Earlier diagnosis and treatment of breast cancer could improve outcomes of women with public health coverage in Brazil. (C)2013 AACR.