Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA.
Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA.
Int J Environ Res Public Health. 2019 Sep 13;16(18):3393. doi: 10.3390/ijerph16183393.
: Scientific evidence on the effect of health insurance on racial disparities in urinary bladder cancer patients' survival is scant. The objective of our study was to determine whether insurance status modifies the association between race and bladder cancer specific survival during 2007-2015. : The 2015 database of the cancer surveillance program of the National Cancer Institute ( = 39,587) was used. The independent variable was race (White, Black and Asian Pacific Islanders (API)), the main outcome was cancer specific survival. Health insurance was divided into uninsured, any Medicaid and insured. An adjusted model with an interaction term for race and insurance status was computed. Unadjusted and adjusted Cox regression analysis were applied. : Health insurance was a statistically significant effect modifier of the association between race and survival. Whereas, API had a lower hazard of death among the patients with Medicaid insurance (HR 0.67; 95% CI 0.48-0.94 compared with White patients, no differences in survival was found between Black and White urinary bladder carcinoma patients (HR 1.24; 95% CI 0.95-1.61). This may be due a lack of power. Among the insured study participants, Blacks were 1.46 times more likely than Whites to die of bladder cancer during the 5-year follow-up (95% CI 1.30-1.64). : While race is accepted as a poor prognostic factor in the mortality from bladder cancer, insurance status can help to explain some of the survival differences across races.
: 关于医疗保险对膀胱癌患者生存的种族差异的影响的科学证据很少。我们的研究目的是确定在 2007-2015 年期间，保险状况是否改变了种族与膀胱癌特定生存率之间的关系。: 使用了国家癌症研究所癌症监测计划 2015 年数据库（=39587）。自变量是种族（白人、黑人、亚太裔美国人（API）），主要结局是癌症特异性生存率。医疗保险分为未参保、任何医疗补助和参保。计算了种族和保险状况之间交互项的调整模型。应用了未经调整和调整后的 Cox 回归分析。: 医疗保险是种族与生存率之间关系的统计学上显著的效应修饰剂。而 API 组中 Medicaid 保险的患者死亡风险较低（HR 0.67；95%CI 0.48-0.94 与白人患者相比，黑人与白人膀胱癌患者的生存率没有差异（HR 1.24；95%CI 0.95-1.61）。这可能是由于缺乏效力。在参保的研究参与者中，黑人死于膀胱癌的风险比白人高 1.46 倍（95%CI 1.30-1.64）。: 虽然种族被认为是膀胱癌死亡率的一个不良预后因素，但保险状况可以帮助解释一些种族间的生存率差异。
