Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Dis Colon Rectum. 2018 May;61(5):538-546. doi: 10.1097/DCR.0000000000001068.
Colon cancer is a common cancer with a relatively high survival for nonmetastatic disease if appropriate treatment is given. A lower survival rate for patients with no or inadequate insurance has previously been documented, but the differences have not been explored in detail on a population level.
The purpose of this study was to examine survival for patients with colon cancer by insurance type.
Complete analysis was used to examine 1-, 2-, and 3-year survival rates.
This was a population-level analysis.
Patients were drawn from the in-patients diagnosed with colon cancer at ages 15 to 64 years between 2007 and 2012 in the Surveillance, Epidemiology, and End Results 18 database by insurance type (Medicaid, uninsured, or other insurance) MAIN OUTCOME MEASURE:: This study measured overall survival.
A total of 57,790 cases were included, with insurance information available for 55,432. Of those, 7611 (13.7%), 4131 (7.5%), and 43,690 (78.8%) had Medicaid, no insurance, or other insurance. Patients with Medicaid or without insurance were more likely to have metastatic disease compared with those with other insurance. Survival was higher for patients with insurance other than Medicaid, with 3-year survival estimates of 57.0%, 61.2%, and 75.6% for Medicaid, uninsured, and other insurance. Significant disparities continued to be observed after adjustment for stage, especially for later-stage disease. When only patients with stage I to II disease who had definitive surgery and resection of ≥12 lymph nodes were included in the analysis, the discrepancy was decreased, especially for uninsured patients.
Information on chemotherapy use and biological markers of disease severity are not available in the database.
Colon cancer survival is lower for patients with no insurance or with Medicaid than for those with private insurance. Differences in rates of definitive surgery and adequate lymph node dissection explain some of this disparity. See Video Abstract at http://links.lww.com/DCR/A585.
结肠癌是一种常见的癌症，如果给予适当的治疗，非转移性疾病的患者生存率相对较高。以前有记录表明，没有保险或保险不足的患者生存率较低，但这些差异在人群层面上尚未得到详细探讨。
本研究旨在检查不同保险类型的结肠癌患者的生存率。
采用完整分析方法检查 1 年、2 年和 3 年的生存率。
这是一项人群水平的分析。
从 2007 年至 2012 年在监测、流行病学和最终结果 18 数据库中，年龄在 15 至 64 岁之间被诊断患有结肠癌的住院患者中，按保险类型（医疗补助、无保险或其他保险）抽取患者。
本研究测量总生存率。
共纳入 57790 例病例，其中 55432 例有保险信息。其中，7611 例（13.7%）、4131 例（7.5%）和 43690 例（78.8%）分别有医疗补助、无保险或其他保险。与其他保险相比，有医疗补助或无保险的患者更有可能患有转移性疾病。有其他保险的患者的生存率更高，3 年生存率估计分别为医疗补助、无保险和其他保险的 57.0%、61.2%和 75.6%。调整分期后，尤其是在晚期疾病患者中，仍然存在显著的差异。当仅纳入接受明确手术和切除≥12 个淋巴结的 I 期至 II 期疾病患者进行分析时，差异减小，尤其是对于无保险患者。
数据库中没有化疗使用和疾病严重程度的生物学标志物信息。
与私人保险相比，没有保险或有医疗补助的结肠癌患者的生存率较低。确定性手术和足够的淋巴结清扫率的差异解释了部分差异。
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