Relationship between insurance status and outcomes for patients with breast cancer in Missouri.
Relationship between insurance status and outcomes for patients with breast cancer in Missouri.
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DOI：
10.1002/cncr.33330
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发表时间：
2021-03-15
期刊：
影响因子：
6.2
通讯作者：
Colditz, Graham A.
中科院分区：
文献类型：
--
作者：
Berrian, Jennifer L.;Liu, Ying;Lian, Min;Schmaltz, Chester L.;Colditz, Graham A.
诊断时的癌症分期、治疗延迟和乳腺癌死亡率因保险状况而异。使用密苏里州癌症登记处，分析包括2007年1月1日至2015年12月31日诊断为浸润性乳腺癌的31，485名女性。使用逻辑回归计算晚期（III-IV期）诊断和治疗延迟（诊断后>60天）的比值比（OR）。我们使用考克斯比例风险回归计算乳腺癌死亡率的风险比（HR）。中介分析用于量化每个协变量对死亡率的个体贡献。与私人保险患者相比，医疗补助患者（OR=1.72，95%置信区间[CI] 1.56-1.91）和无保险患者（OR=2.30，95% CI：1.91-2.78）的晚期诊断OR更高。医疗保险（OR=1.21，95%CI：1.10-1.37）、医疗补助（OR=1.60，95%CI：1.37-1.85）和无保险（OR=1.58，95%CI：1.18-2.12）患者治疗延迟的几率较高。在公共保险组和无保险组中，乳腺癌特异性死亡率的HR显著增加，在对社会人口统计学因素（HR=2.39，95% CI：1.96-2.91）、肿瘤特征（HR=1.28，95% CI：1.05-1.56）和治疗（HR=1.23，95% CI：1.01-1.50）进行序贯调整后下降。晚期诊断占未投保乳腺癌死亡率的72.5%。与私人保险相比，有公共保险或没有保险的妇女患晚期乳腺癌的风险更高，治疗延迟超过60天，死于乳腺癌。特别是对于没有保险的人来说，医疗补助的扩大和对教育和筛查项目的增加可以减少乳腺癌的差异。对于密苏里州的乳腺癌患者，我们发现与私人保险患者相比，医疗补助保险和未保险患者的晚期诊断风险，>60天治疗延迟和乳腺癌特异性死亡率显着增加。医疗补助的扩大和增加对筛查和教育项目的资助可以帮助缩小密苏里州未参保人群在乳腺癌护理和结果方面的差距。
Cancer stage at diagnosis, treatment delay, and breast cancer mortality vary by insurance status. Using the Missouri Cancer Registry, the analysis included 31,485 women diagnosed with invasive breast cancer from January 1, 2007 to December 31, 2015. Odds ratios (ORs) of late-stage (stage III-IV) diagnosis and treatment delay (>60 days after diagnosis) were calculated using logistic regression. We calculated the hazard ratio (HR) of breast cancer mortality using Cox proportional hazards regression. Mediation analysis was used to quantify the individual contributions of each covariate on mortality. The OR of late-stage diagnosis was higher for patients with Medicaid (OR=1.72, 95% confidence interval [CI] 1.56–1.91) and no insurance (OR=2.30, 95% CI: 1.91–2.78), compared to privately insured patients. Medicare (OR=1.21, 95% CI: 1.10–1.37), Medicaid (OR=1.60, 95% CI: 1.37–1.85) and uninsured (OR=1.58, 95% CI: 1.18–2.12) patients had higher odds of treatment delay. The HR of breast cancer-specific mortality was significantly increased in the groups of public insurance and no insurance, decreasing after sequential adjustment for sociodemographic factors (HR=2.39, 95% CI: 1.96–2.91), tumor characteristics (HR=1.28, 95% CI: 1.05–1.56), and treatment (HR=1.23, 95% CI: 1.01–1.50). Late-stage diagnosis accounted for 72.5% of breast cancer mortality in the uninsured. Compared to the privately insured, women with public or no insurance had higher risk of advanced breast cancer and a >60-day treatment delay, and death from breast cancer. Particularly for the uninsured, Medicaid expansion and increased funding for education and screening programs could decrease breast cancer disparities. For breast cancer patients in Missouri, we found significant increases in the risks of late stage diagnosis, >60 day treatment delay, and breast cancer-specific mortality for Medicaid-insured and uninsured patients, compared to privately insured patients. Medicaid expansion and increased funding to screening and education programs could help reduce the disparity gap in breast cancer care and outcomes for the uninsured in Missouri.
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