Chouaïd Christos, Debieuvre Didier, Durand-Zaleski Isabelle, Fernandes Jérôme, Scherpereel Arnaud, Westeel Virginie, Blein Cécile, Gaudin Anne-Françoise, Ozan Nicolas, Leblanc Soline, Vainchtock Alexandre, Chauvin Pierre, Cotté François-Emery, Souquet Pierre-Jean
Department of Chest Medicine, Créteil University Hospital, Créteil, France.
Department of Chest Medicine, Mulhouse University Hospital, Mulhouse, France.
PLoS One. 2017 Aug 25;12(8):e0182798. doi: 10.1371/journal.pone.0182798. eCollection 2017.
The French healthcare system is a universal healthcare system with no financial barrier to access to health services and cancer drugs. The objective of the study is to investigate associations between, on the one hand, incidence and survival of patients diagnosed with lung cancer in France and, on the other, the socioeconomic deprivation and population density of their municipality of residence. A national, longitudinal analysis using data from the French National Hospital database crossed with the population density of the municipality and a social deprivation index based on census data aggregated at the municipality level. For lung cancer diagnosed at the metastatic stage, one-year and two-year survival was not associated with the population density of the municipality of residence. In contrast, mortality was higher for people living in very deprived, deprived and privileged areas compared to very privileged areas (hazard ratios at two years: 1.19 [1.13-1.25], 1.14 [1.08-1.20] and 1.10 [1.04-1.16] respectively). Similar associations are also observed in patients diagnosed with non-metastatic disease (hazard ratios at two years: 1.21 [1.13-1.30], 1.15 [1.08-1.23] and 1.10 [1.03-1.18] for people living in very deprived, deprived and privileged areas compared to very privileged areas). Despite a universal healthcare coverage, survival inequalities in patients with lung cancer can be observed in France with respect to certain socioeconomic indicators.
法国医疗体系是一种全民医疗体系，在获取医疗服务和癌症药物方面不存在经济障碍。本研究的目的是调查一方面法国肺癌患者的发病率和生存率与另一方面他们居住市镇的社会经济剥夺程度和人口密度之间的关联。使用法国国家医院数据库的数据与市镇人口密度以及基于市镇层面汇总的人口普查数据的社会剥夺指数进行全国性纵向分析。对于诊断为转移性阶段的肺癌，一年和两年生存率与居住市镇的人口密度无关。相比之下，与非常富裕地区相比，生活在极度贫困、贫困和富裕地区的人的死亡率更高（两年时的风险比分别为：1.19 [1.13 - 1.25]、1.14 [1.08 - 1.20] 和 1.10 [1.04 - 1.16]）。在诊断为非转移性疾病的患者中也观察到类似的关联（与非常富裕地区相比，生活在极度贫困、贫困和富裕地区的人的两年风险比分别为：1.21 [1.13 - 1.30]、1.15 [1.08 - 1.23] 和 1.10 [1.03 - 1.18]）。尽管有全民医保覆盖，但在法国，就某些社会经济指标而言，肺癌患者的生存不平等现象依然存在。
