Tin Tin Sandar, Elwood J Mark, Lawrenson Ross, Campbell Ian, Harvey Vernon, Seneviratne Sanjeewa
Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
PLoS One. 2016 Apr 7;11(4):e0153206. doi: 10.1371/journal.pone.0153206. eCollection 2016.
Patients who received private health care appear to have better survival from breast cancer compared to those who received public care. This study investigated if this applied to New Zealand women and identified factors that could explain such disparities.
This study involved all women who were diagnosed with primary breast cancer in two health regions in New Zealand, covering about 40% of the national population, between June 2000 and May 2013. Patients who received public care for primary treatment, mostly surgical treatment, were compared with those who received private care in terms of demographics, mode of presentation, disease factors, comorbidity index and treatment factors. Cox regression modelling was performed with stepwise adjustments, and hazards of breast cancer specific mortality associated with the type of health care received was assessed.
Of the 14,468 patients, 8,916 (61.6%) received public care. Compared to patients treated in private care facilities, they were older, more likely to be Māori, Pacifika or Asian and to reside in deprived neighbourhoods and rural areas, and less likely to be diagnosed with early staged cancer and to receive timely cancer treatments. They had a higher risk of mortality from breast cancer (hazard ratio: 1.95; 95% CI: 1.75, 2.17), of which 80% (95% CI: 63%, 100%) was explained by baseline differences, particularly related to ethnicity, stage at diagnosis and type of loco-regional therapy. After controlling for these demographic, disease and treatment factors, the risk of mortality was still 14% higher in the public sector patients.
Ethnicity, stage at diagnosis and type of loco-regional therapy were the three key contributors to survival disparities between patients treated in public and private health care facilities in New Zealand. The findings underscore the need for more efforts to improve the quality, timeliness and equitability of public cancer care services.
与接受公共医疗服务的患者相比，接受私人医疗服务的乳腺癌患者似乎具有更好的生存率。本研究调查了这一情况是否适用于新西兰女性，并确定了可能解释这种差异的因素。
本研究纳入了2000年6月至2013年5月期间在新西兰两个卫生区域被诊断为原发性乳腺癌的所有女性，这两个区域覆盖了约40%的全国人口。将接受公共医疗服务进行初始治疗（主要是手术治疗）的患者与接受私人医疗服务的患者在人口统计学、就诊方式、疾病因素、合并症指数和治疗因素方面进行比较。采用逐步调整的Cox回归模型，评估与所接受的医疗服务类型相关的乳腺癌特异性死亡风险。
在14468名患者中，8916名（61.6%）接受了公共医疗服务。与在私人医疗机构接受治疗的患者相比，他们年龄更大，更有可能是毛利人、太平洋岛民或亚洲人，居住在贫困社区和农村地区，被诊断为早期癌症并接受及时癌症治疗的可能性更小。他们患乳腺癌死亡的风险更高（风险比：1.95；95%置信区间：1.75，2.17），其中80%（95%置信区间：63%，100%）可由基线差异解释，特别是与种族、诊断时的分期和局部区域治疗类型有关。在控制了这些人口统计学、疾病和治疗因素后，公共部门患者的死亡风险仍然高出14%。
种族、诊断时的分期和局部区域治疗类型是新西兰公共和私人医疗机构治疗的患者生存差异的三个关键因素。研究结果强调需要做出更多努力来提高公共癌症护理服务的质量、及时性和公平性。
