Health Services Research, American Cancer Society, Atlanta, Georgia.
Cancer. 2014 Apr 15;120(8):1212-9. doi: 10.1002/cncr.28568. Epub 2014 Jan 28.
The percentage of adolescent and young adult (AYA) patients with cancer (those aged 15-39 years) diagnosed at a distant stage of disease did not significantly change between 1975 and 2004. It has been hypothesized that a lack of health insurance may be a significant risk factor for a diagnosis of distant-stage disease among AYA patients, but to the authors' knowledge this has not been examined in a national sample.
The National Cancer Data Base, a hospital-based cancer registry, was used to obtain data regarding incident cancer cases among patients aged 15 years to 39 years who were diagnosed between 2004 and 2010. After all exclusions, a total of 285,448 cases were available for analysis; all AYA cancer sites were included. A retrospective study was conducted to assess the association between insurance status and stage of disease at diagnosis.
After adjusting for age, race/ethnicity, facility type, ZIP code-based income and education levels, and US Census region, it was found that among males, uninsured patients were 1.51 times more likely to be diagnosed at a distant stage of disease compared with patients with private insurance (95% confidence interval, 1.46-1.55). Among females, the effect of insurance was stronger, with uninsured patients found to be 1.86 times more likely to be diagnosed at a distant stage (95% confidence interval, 1.79-1.94). The effect of insurance status was substantially stronger for malignancies that are more amenable to early detection (melanoma, thyroid carcinoma, breast carcinoma, genitourinary carcinoma), and substantially weaker for those that are less amenable to early detection (lung carcinoma, adrenocortical carcinoma, Wilms tumor).
In a large national sample of AYA patients with cancer, insurance status was found to be a strong independent risk factor for distant-stage disease at the time of diagnosis.
1975 年至 2004 年间，青少年和年轻成人（AYA）癌症患者（年龄在 15-39 岁之间）的远处期疾病诊断百分比并未显著变化。据推测，缺乏健康保险可能是 AYA 患者远处期疾病诊断的一个重要危险因素，但据作者所知，这在全国样本中尚未得到检验。
国家癌症数据库是一个基于医院的癌症登记处，用于获取 2004 年至 2010 年间诊断的年龄在 15 岁至 39 岁之间的癌症患者的发病数据。排除所有排除因素后，共有 285448 例病例可供分析；所有 AYA 癌症部位均包括在内。进行了一项回顾性研究，以评估保险状况与诊断时疾病分期之间的关系。
在调整了年龄、种族/族裔、医疗机构类型、邮政编码收入和教育水平以及美国人口普查区后，发现男性中，与有私人保险的患者相比，无保险患者被诊断为远处期疾病的可能性高 1.51 倍（95%置信区间，1.46-1.55）。对于女性，保险的影响更大，无保险患者被诊断为远处期疾病的可能性高 1.86 倍（95%置信区间，1.79-1.94）。保险状况对更易早期发现的恶性肿瘤（黑色素瘤、甲状腺癌、乳腺癌、泌尿生殖系统癌）的影响要强得多，而对较不易早期发现的恶性肿瘤（肺癌、肾上腺皮质癌、肾母细胞瘤）的影响要弱得多。
在一项针对患有癌症的大量 AYA 患者的大型全国性样本中，发现保险状况是诊断时远处期疾病的一个强有力的独立危险因素。
