Ortiz-Ortiz Karen J, Ramírez-García Roberto, Cruz-Correa Marcia, Ríos-González Moraima Y, Ortiz Ana Patricia
Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
PLoS One. 2014 May 5;9(5):e96746. doi: 10.1371/journal.pone.0096746. eCollection 2014.
Colorectal cancer represents a major health problem and an important economic burden in Puerto Rico. In the 1990's, the Commonwealth of Puerto Rico implemented a health care reform through the privatization of the public health system. The goal was to ensure access to health services, eliminate disparities for medically indigent citizens and provide special coverage for high-risk conditions such as cancer. This study estimates the 5-year relative survival rate of colorectal cancer and the relative excess risk of death in Puerto Rico for 2004-2005, by type of health insurance coverage; Government Health Plan vs. Non-Government Health Plan. Colorectal cancer in advanced stages was more common in Government Health Plan patients compared with Non-Government Health Plan patients (44.29% vs. 40.24 had regional extent and 13.58% versus 10.42% had distant involvement, respectively). Government Health Plan patients in the 50-64 (RR = 6.59; CI: 2.85-15.24) and ≥65 (RR = 2.4; CI: 1.72-4.04) age-groups had the greater excess risk of death compared with Non-Government Health Plan patients. Further studies evaluating the interplay of access to health services and the barriers affecting the Government Health Plan population are warranted.
在波多黎各，结直肠癌是一个重大的健康问题，也是一项重要的经济负担。20世纪90年代，波多黎各联邦通过公共卫生系统私有化实施了一项医疗改革。其目标是确保获得医疗服务，消除医疗贫困公民之间的差距，并为癌症等高风险疾病提供特殊保险。本研究按医疗保险覆盖类型（政府健康计划与非政府健康计划）估算了2004 - 2005年波多黎各结直肠癌的5年相对生存率和相对超额死亡风险。与非政府健康计划患者相比，晚期结直肠癌在政府健康计划患者中更为常见（区域扩散分别为44.29%对40.24%，远处转移分别为13.58%对10.42%）。50 - 64岁（RR = 6.59；CI：2.85 - 15.24）和≥65岁（RR = 2.4；CI：1.72 - 4.04）年龄组的政府健康计划患者与非政府健康计划患者相比，有更高的超额死亡风险。有必要进一步开展研究，评估获得医疗服务的相互作用以及影响政府健康计划人群的障碍。
