Pulte Dianne, Castro Felipe A, Brenner Hermann, Jansen Lina
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Hematology, Thomas Jefferson University, Philadelaphia, PA, USA.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Leuk Res. 2017 May;56:75-81. doi: 10.1016/j.leukres.2017.02.001. Epub 2017 Feb 3.
Survival for patients with acute myeloblastic leukemia (AML) has increased during the past two decades. However, socioeconomic disparities may affect survival for some patient populations. We examine survival by insurance type for patients with AML. Using data from the Surveillance, Epidemiology, and End Results database we estimated survival according to insurance status (no insurance, Medicaid, and other insurance) for patients diagnosed with AML in the United States in 2007-2013. One, 3-, and 5-year survival was lower for patients with no insurance and Medicaid than for patients with other insurance. Five-year survival estimates were 24.7%, 25.6%, and 35.7%, respectively, for patients with Medicaid, no insurance, and other insurance. After adjustment, hazard ratios of 1.46 for uninsured and 1.35 for Medicaid compared to other insurance for overall survival and 1.50 for uninsured and 1.30 for Medicaid compared to other insurance for AML-specific survival were observed. Similar results were seen in all ages and both genders. Patients with no insurance or Medicaid have lower survival expectations after diagnosis with AML than patients with other insurance. Further research into reasons for the poor outcomes for Medicaid patients and continued reduction of number of uninsured people are urgently needed to improve population-level outcomes for AML.
在过去二十年中，急性髓细胞白血病（AML）患者的生存率有所提高。然而，社会经济差异可能会影响某些患者群体的生存情况。我们研究了AML患者按保险类型划分的生存率。利用监测、流行病学和最终结果数据库的数据，我们估算了2007年至2013年在美国被诊断为AML的患者按保险状况（无保险、医疗补助和其他保险）划分的生存率。无保险和有医疗补助的患者1年、3年和5年生存率低于有其他保险的患者。医疗补助患者、无保险患者和有其他保险患者的5年生存率估计分别为24.7%、25.6%和35.7%。调整后，观察到与其他保险相比，无保险患者的总生存风险比为1.46，医疗补助患者为1.35；与其他保险相比，无保险患者的AML特异性生存风险比为1.50，医疗补助患者为1.30。在所有年龄组和两性中均观察到类似结果。与有其他保险的患者相比，无保险或有医疗补助的患者在诊断为AML后的生存预期较低。迫切需要进一步研究医疗补助患者预后不良的原因，并持续减少无保险人数，以改善AML患者群体层面的预后。
