医疗保险状况对马萨诸塞州一家三级保健中心宫颈癌诊断阶段的影响。
The impact of health insurance status on the stage of cervical cancer diagnosis at a tertiary care center in Massachusetts.
机构信息
Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Division of Gynecologic and Obstetric Pathology, Department of Pathology, Duke University Medical Center, Durham, NC, United States.
出版信息
Gynecol Oncol. 2018 Jul;150(1):67-72. doi: 10.1016/j.ygyno.2018.05.002. Epub 2018 May 9.
OBJECTIVE
To evaluate the impact of insurance status on the stage of cervical cancer diagnosed and treated at a tertiary care center in Massachusetts and review the preceding screening history.
METHODS
An IRB approved retrospective cohort study was conducted of patients with a diagnosis of cervical cancer treated at Brigham and Women's Hospital (BWH) between January 2011 and June 2016. Clinical and demographic data was extracted from the longitudinal medical record. Statistical analysis was performed using SAS.
RESULTS
117 cases of cervical cancer met the inclusion criteria during the study period. Most patients (76%) were diagnosed with stage I disease. On univariate analysis, compared to patients with private insurance, patients with public insurance or no documented insurance presented at older ages, were more likely to be non-white races, and present with advanced stage disease. In an adjusted model, the risk of being diagnosed with advanced stage disease persisted among women with public or no documented insurance, adjusted odds ratio (aOR) 4.13 (1.37-12.45). There was no difference in screening history among women with private vs. public insurance, p = 0.30.
CONCLUSIONS
Despite access to insurance, patients with public issued insurance had an increased risk of presenting with advanced stage cervical cancer in this cohort. These data suggest that additional barriers to screening and prevention may exist and are important for future investigation.
目的
评估保险状况对马萨诸塞州一家三级护理中心诊断和治疗的宫颈癌分期的影响，并回顾既往筛查史。
方法
对 2011 年 1 月至 2016 年 6 月在布莱根妇女医院（BWH）治疗的宫颈癌患者进行了一项经机构审查委员会批准的回顾性队列研究。从纵向病历中提取临床和人口统计学数据。使用 SAS 进行统计分析。
结果
在研究期间，117 例宫颈癌符合纳入标准。大多数患者（76%）被诊断为 I 期疾病。单因素分析显示，与有私人保险的患者相比，有公共保险或无保险记录的患者年龄较大，更可能是非白色人种，且疾病分期较晚。在调整模型中，公共保险或无保险记录的女性患晚期疾病的风险持续存在，调整后的优势比（aOR）为 4.13（1.37-12.45）。有私人保险和公共保险的女性在筛查史方面没有差异，p=0.30。
结论
尽管有保险，但在本队列中，有公共保险的患者出现晚期宫颈癌的风险增加。这些数据表明，可能存在额外的筛查和预防障碍，这对于未来的研究很重要。
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