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Macroeconomic environment and insurance-mortality relationship: An analysis of gender-based disparity among non-elderly adult patients of melanoma and lung cancer.
宏观经济环境与保险-死亡率关系: 非老年成人黑色素瘤和肺癌患者基于性别的差异分析。
- 影响因子:2.24
- DOI:10.1111/ecc.13229
- 作者列表:"Adnan H","Adnan SM","Deng K","Yang C","Hou Y","Ngo Nkondjock VR","Li K
- 发表时间:2020-02-03
Abstract
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.
摘要
目的: 癌症患者在人口统计学部门以及保险集团之间表现出死亡风险的差异。宏观经济环境的影响也因此类阶层而异。本研究分析了有保险和无保险的男性和女性癌症患者的死亡风险之间的差距,并探讨了这些差距如何随着宏观经济的变化而随着时间的推移而变化。 方法: 从监测流行病学学和最终结果 (SEER) 数据库中提取 45,750-91,157 和 2007-2009 年诊断的 2011 例黑色素瘤和 2013 例肺癌患者的人口统计学、临床和治疗记录。应用 Kaplan-Meier 检验确定每个保险组的生存概率,同时使用 Cox 比例风险模型评估医疗补助和未保险患者的相对死亡风险, 对于整个数据以及单独的时间段和性别。 结果: 无保险的女性患者的风险比及其随时间的变化均大于男性患者。与任何保险性别亚组相比,未保险的黑色素瘤女性患者的风险比大大增加,从 1.41 [95% 置信区间 (CI),1.04-1.92] 增加到 2.22 [95% CI, 1.67-2.94]。 结论: 尽管诊断改进和技术进步,宏观经济危机的不利影响与没有保险的癌症患者的相对死亡风险增加有关,女性多于男性。
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