Pisu Maria, Azuero Andres, Benz Rachel, McNees Patrick, Meneses Karen
Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.
Cancer Med. 2017 Mar;6(3):572-581. doi: 10.1002/cam4.1017. Epub 2017 Feb 23.
Little is known about out-of-pocket (OOP) costs incurred for medical and health needs by rural breast cancer survivors and what factors may be associated with higher OOP costs and the associated economic burden. Data were examined for 432 survivors participating in the Rural Breast Cancer Survivor Intervention trial. OOP costs were collected using the Work and Finances Inventory survey at baseline and four assessments every 3 months. Mean and median OOP costs and burden (percent of monthly income spent on OOP costs) were reported and factors associated with OOP costs and burden identified with generalized linear models fitted with over-dispersed gamma distributions and logarithmic links (OOP costs) and with beta distributions with logit link (OOP burden). OOP costs per month since the end of treatment were on average $232.7 (median $95.6), declined at the next assessment point to $186.5 (median $89.1), and thereafter remained at that level. Mean OOP burden was 9% at baseline and between 7% and 8% at the next assessments. Factors suggestive of contributing to higher OOP costs and OOP burden were the following: younger age, lower income, time in survivorship from diagnosis, and use of supportive services. OOP costs burden rural breast cancer survivors, particularly those who are younger and low income. Research should investigate the impact of OOP costs and interventions to reduce economic burden.
对于农村乳腺癌幸存者因医疗和健康需求而产生的自付费用，以及哪些因素可能与较高的自付费用及其相关经济负担有关，我们知之甚少。对参与农村乳腺癌幸存者干预试验的432名幸存者的数据进行了研究。自付费用通过工作和财务清单调查在基线时收集，并每3个月进行四次评估。报告了自付费用和负担的均值和中位数（自付费用占月收入的百分比），并使用拟合过度分散伽马分布和对数链接（自付费用）以及具有logit链接的贝塔分布（自付负担）的广义线性模型确定了与自付费用和负担相关的因素。治疗结束后每月的自付费用平均为232.7美元（中位数为95.6美元），在下一个评估点降至186.5美元（中位数为89.1美元），此后保持在该水平。基线时的平均自付负担为9%，在下一次评估时为7%至8%。表明导致较高自付费用和自付负担的因素如下：年龄较小、收入较低、从诊断开始的存活时间以及使用支持性服务。自付费用给农村乳腺癌幸存者带来负担，尤其是那些年轻且低收入的幸存者。研究应调查自付费用的影响以及减轻经济负担的干预措施。
