Phimha Surachai, Promthet Supannee, Suwanrungruang Krittika, Chindaprasirt Jarin, Bouphan Prachak, Santong Chalongpon, Vatanasapt Patravoot
Doctor of Philosophy Program in Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Khon Kaen, Thailand. Email:
Asian Pac J Cancer Prev. 2019 Jun 1;20(6):1797-1802. doi: 10.31557/APJCP.2019.20.6.1797.
Background: Evidence from healthcare studies demonstrates that patients’ health insurance affects service accessibility and the outcome of treatment. However, assessment on how colorectal cancer survival relates to health insurance is limited. Objective: The study examined the association between health insurance and colorectal cancer survival in Khon Kaen, Thailand. Methods: The retrospective cohort study was conducted with 1,931 colorectal cancer patients from Khon Kaen cancer registry between January 1, 2003 and December 31, 2012, and was followed-up until December 31, 2015. Relative survival was used to estimate the survival rate. Cox proportional hazard regression was used to estimate the relationship between health insurance and colorectal cancer survival, represented with the hazard ratio. Result: Most of the participants were males, and the median age was 62 years. The median survival time was 2.25 years (95% CI: 2.00-2.51). The five-year observed survival rate and relative survival rate were 36.87 (95% CI: 34.66-39.08) and, 42.28 (95% CI: 39.75-44.81), respectively. The factors that showed significant associations with poorer survival after adjustment for gender and age were non-surgical treatments (HRadj=1.88;95%CI=1.45-2.45), advanced stage (III+IV) (HRadj=2.50; 95%CI=2.00-3.12), histological grading in poorly differentiated (HRadj=1.84; 95%CI=1.32-2.56), and Universal Coverage Scheme (HRadj=1.37;95%CI=1.09-1.72). Conclusion: The survival of colorectal cancer patients in the Universal Coverage Scheme was likely to be poorer than in the Civil Servant Medical Benefit Scheme. This indicates an urgent need for a national program for colorectal cancer screening in the general population and access to health insurance.
医疗保健研究的证据表明，患者的健康保险会影响服务可及性和治疗结果。然而，关于结直肠癌生存率与健康保险之间关系的评估有限。目的：本研究调查了泰国孔敬地区健康保险与结直肠癌生存率之间的关联。方法：对2003年1月1日至2012年12月31日期间孔敬癌症登记处的1931例结直肠癌患者进行回顾性队列研究，并随访至2015年12月31日。采用相对生存率来估计生存率。使用Cox比例风险回归来估计健康保险与结直肠癌生存率之间的关系，以风险比表示。结果：大多数参与者为男性，中位年龄为62岁。中位生存时间为2.25年（95%置信区间：2.00 - 2.51）。五年观察生存率和相对生存率分别为36.87（95%置信区间：34.66 - 39.08）和42.28（95%置信区间：39.75 - 44.81）。在对性别和年龄进行调整后，与较差生存率显示出显著关联的因素包括非手术治疗（校正后风险比=1.88；95%置信区间=1.45 - 2.45）、晚期（III + IV期）（校正后风险比=2.50；95%置信区间=2.00 - 3.12）、低分化组织学分级（校正后风险比=1.84；95%置信区间=1.32 - 2.56）以及全民覆盖计划（校正后风险比=1.37；95%置信区间=1.09 - 1.72）。结论：全民覆盖计划中的结直肠癌患者生存率可能低于公务员医疗福利计划中的患者。这表明迫切需要在普通人群中开展全国性的结直肠癌筛查计划以及获得健康保险。
