Takenaka Yukinori, Yasui Toshimichi, Enomoto Keisuke, Miyabe Haruka, Morizane Natsue, Ashida Naoki, Shimizu Kotaro, Hirose Masayuki, Yamamoto Yoshifumi, Uno Atsuhiko
Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi, Osaka, Japan.
Int J Clin Oncol. 2016 Jun;21(3):517-22. doi: 10.1007/s10147-015-0921-5. Epub 2015 Nov 7.
Healthcare systems vary among countries, and in many countries, insurance and economic statuses significantly impact the mortality associated with head and neck squamous cell carcinoma (HNSCC). Japan prides itself on its unique healthcare and health insurance system, which provides equal coverage and healthcare access with low individual payments to most citizens. Additionally, citizens in poverty are covered by insurance for the poor (public assistance) and receive medical and other types of assistance. Hence, they have no barriers to healthcare services. This study aimed to determine the impact of health insurance status on mortality in Japanese patients with HNSCC.
We reviewed 409 patients with HNSCC, using the Kaplan-Meier method to estimate overall survival. The association between insurance status and disease stage at diagnosis was analyzed via logistic regression. Cox and Fine-Gray proportional hazard models were employed to investigate the impact of insurance status on survival.
The public assistance and other insurances groups did not significantly differ in clinical stage distribution. The 5-year overall survival, cumulative incidence of HNSCC death, and cumulative incidence of other death rates were 63.3 and 59.1 %, 27.0 and 31.8 %, and 10.3 and 9.7 % for the public assistance and other insurances groups, respectively. The adjusted subdistribution hazard ratio for the association between public assistance and HNSCC death was 0.73 (95 % confidence interval 0.44-1.21).
The demonstrated non-inferiority of public assistance regarding HNSCC-specific mortality indicates the equality of healthcare in Japan, irrespective of the insurance status, and the superiority of the Japanese healthcare system.
各国医疗保健系统各不相同，在许多国家，保险和经济状况对与头颈部鳞状细胞癌（HNSCC）相关的死亡率有显著影响。日本以其独特的医疗保健和健康保险系统而自豪，该系统为大多数公民提供平等的保险范围和医疗保健服务，个人支付费用较低。此外，贫困公民由贫困保险（公共援助）覆盖，并获得医疗和其他类型的援助。因此，他们在获得医疗服务方面没有障碍。本研究旨在确定健康保险状况对日本HNSCC患者死亡率的影响。
我们回顾了409例HNSCC患者，采用Kaplan-Meier方法估计总生存期。通过逻辑回归分析保险状况与诊断时疾病分期之间的关联。采用Cox和Fine-Gray比例风险模型研究保险状况对生存的影响。
公共援助组和其他保险组在临床分期分布上无显著差异。公共援助组和其他保险组的5年总生存率、HNSCC死亡累积发生率和其他死亡率累积发生率分别为63.3%和59.1%、27.0%和31.8%、10.3%和9.7%。公共援助与HNSCC死亡之间关联的调整后亚分布风险比为0.73（95%置信区间0.44-1.21）。
公共援助在HNSCC特异性死亡率方面表现出的非劣效性表明，无论保险状况如何，日本的医疗保健具有平等性，且日本医疗保健系统具有优越性。
