Kaul Sapna, Avila Jaqueline C, Jupiter Daniel, Rodriguez Ana M, Kirchhoff Anne C, Kuo Yong-Fang
Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd., Ewing Hall Suite 1.128, Galveston, TX, 77555, USA.
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA.
J Cancer Res Clin Oncol. 2017 Dec;143(12):2469-2480. doi: 10.1007/s00432-017-2494-3. Epub 2017 Aug 22.
To examine the associations between modifiable health-related factors, such as smoking, low physical activity and higher body mass index (BMI), and annual health care visits and expenditures among adult cancer survivors in the United States.
Using data from the 2010-2014 Medical Expenditures Panel Survey, we identified 4920 cancer survivors (aged 18-64 years) and a matched comparison group. Our outcomes were number of annual health care visits [i.e., outpatient/office-based, hospital discharges and emergency department (ED) visits] and total health care expenditures. We examined health-related factors, demographics, insurance and health status (i.e., comorbidity and mental distress). Bivariate and multivariable analyses examined the associations between outcomes and health-related factors.
Of survivors, approximately 21% were current smokers, 52% reported low physical activity and 35% were obese, vs. 19.6, 49.5 and 36.7%, respectively, of the comparison group. These factors were associated with greater comorbidity and mental distress in both groups. Current smokers among survivors were less likely to have outpatient visits [marginal effect on the number of visits (ME) = -3.44, 95% confidence interval (CI) -5.02 to -1.86, P < 0.001] but more likely to have ED visits (ME = 0.11, 95% CI 0.05-0.18, P = 0.001) than non-smokers. Physically active individuals in both groups had fewer ED visits, and lower total expenditures than those who reported low physical activity.
Regular assessments of health-related factors should be incorporated in survivorship care to reduce the burden of cancer. Modification of survivors' health-related factors (e.g., low physical activity) may help improve their health outcomes and reduce financial burden.
研究美国成年癌症幸存者中可改变的健康相关因素，如吸烟、低体力活动和较高的体重指数（BMI）与年度医疗保健就诊次数和费用之间的关联。
利用2010 - 2014年医疗支出面板调查的数据，我们确定了4920名癌症幸存者（年龄在18 - 64岁之间）和一个匹配的对照组。我们的结果指标是年度医疗保健就诊次数[即门诊/基于办公室的就诊、住院出院和急诊科（ED）就诊]以及总医疗保健支出。我们研究了健康相关因素、人口统计学特征、保险和健康状况（即合并症和精神困扰）。双变量和多变量分析研究了结果指标与健康相关因素之间的关联。
在幸存者中，约21%为当前吸烟者，52%报告体力活动不足，35%肥胖，而对照组的相应比例分别为19.6%、49.5%和36.7%。这些因素在两组中均与更高的合并症和精神困扰相关。幸存者中的当前吸烟者比非吸烟者进行门诊就诊的可能性更小[就诊次数的边际效应（ME）= -3.44，95%置信区间（CI）-5.02至-1.86，P < 0.001]，但进行急诊科就诊的可能性更大（ME = 0.11，95% CI 0.05 - 0.18，P = 0.001）。两组中体力活动活跃的个体比报告体力活动不足的个体进行急诊科就诊的次数更少，总支出也更低。
应将对健康相关因素的定期评估纳入癌症幸存者护理中，以减轻癌症负担。改变幸存者的健康相关因素（如低体力活动）可能有助于改善他们的健康结果并减轻经济负担。
