Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; School of Nursing and Health, Henan University, Kaifeng, Henan, China.
Department of Genetics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China.
Curr Probl Cancer. 2020 Feb;44(1):100505. doi: 10.1016/j.currproblcancer.2019.100505. Epub 2019 Sep 17.
Our goal was to investigate the effect of insurance status on the overall survival (OS) in cases of small intestine adenocarcinoma.
The SEER (Surveillance, Epidemiology, and End Results) database was used to identify 3822 patients who were diagnosed with small intestine adenocarcinoma between 2007 and 2015. The proportional hazard ASSUMPTION was evaluated by proportional-hazards assumption test and Schoenfeld residual test. The Kaplan-Meier method and Cox proportional-hazards regression analysis were performed to evaluate the association between insurance status and OS.
We found that the insurance status at the time of diagnosis affected OS at the population level, both in those aged <65 and ≥65 years. Cox multivariate analysis of patients aged <65 years revealed that the hazard of death was greater in the Medicaid group (hazard ratio [HR] = 1.641, 95% confidence interval [CI] = 1.299-2.073, P < 0.001] and uninsured group (HR = 1.472, 95% CI = 1.095-1.979, P = 0.010) compared with the insured group, while the OS did not differ significantly between the Medicaid and uninsured groups. Similarly, the hazard of death among patients aged ≥65 years was higher in the Medicaid than the insured group (HR = 1.403, 95% CI = 1.136-1.733, P = 0.002).
Our results suggest that patients with small intestine adenocarcinoma with insurance coverage have a significantly better OS than patients who have Medicaid or are uninsured, while the OS does not differ between Medicaid and uninsured patients.
我们的目的是研究保险状况对小肠腺癌患者总体生存（OS）的影响。
利用 SEER（监测、流行病学和最终结果）数据库，确定了 2007 年至 2015 年间诊断为小肠腺癌的 3822 例患者。采用比例风险假设检验和 Schoenfeld 残差检验评估比例风险假设。采用 Kaplan-Meier 方法和 Cox 比例风险回归分析评估保险状况与 OS 之间的关系。
我们发现，诊断时的保险状况影响了<65 岁和≥65 岁人群的 OS。<65 岁患者的 Cox 多变量分析显示，医疗补助组（危险比[HR] = 1.641，95%置信区间[CI] = 1.299-2.073，P < 0.001）和无保险组（HR = 1.472，95% CI = 1.095-1.979，P = 0.010）的死亡风险高于有保险组，而医疗补助组和无保险组的 OS 无显著差异。同样，≥65 岁患者中 Medicaid 组的死亡风险高于有保险组（HR = 1.403，95% CI = 1.136-1.733，P = 0.002）。
我们的结果表明，有保险的小肠腺癌患者的 OS 明显优于有医疗补助或无保险的患者，而 Medicaid 组和无保险组的 OS 无差异。
