Fischer Igor, Mijderwijk Hendrik-Jan, Kahlert Ulf D, Rapp Marion, Sabel Michael, Hänggi Daniel, Steiger Hans-Jakob, Forster Marie-Therese, Kamp Marcel A
Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Division of Informatics and Statistics, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Neurooncol Pract. 2020 Jun 6;7(5):531-540. doi: 10.1093/nop/npaa030. eCollection 2020 Oct.
Prior studies have suggested an association between patient socioeconomic status and brain tumors. In the present study we attempt to indirectly validate the findings, using health insurance status as a proxy for socioeconomic status.
There are 2 types of health insurance in Germany: statutory and private. Owing to regulations, low- and middle-income residents are typically statutory insured, whereas high-income residents have the option of choosing a private insurance. We compared the frequencies of privately insured patients suffering from malignant neoplasms of the brain with the corresponding frequencies among other neurosurgical patients at our hospital and among the German population. To correct for age, sex, and distance from the hospital, we included these variables as predictors in logistic and binomial regression.
A significant association (odds ratio [OR] = 1.59, CI = 1.45-1.74, < .001) between health insurance status and brain tumors was found. The association is independent of patients' sex or age. Whereas privately insured patients generally tend to come from farther away, such a relationship was not observed for patients suffering from brain tumors. Comparing the out of house and in-house brain tumor patients showed no selection bias on our side.
Previous studies have found that people with a higher income, level of education, or socioeconomic status are more likely to suffer from malignant brain tumors. Our findings are in line with these studies. Although the reason behind the association remains unclear, the probability that our results are due to some random effect in the data is extremely low.
先前的研究表明患者社会经济地位与脑肿瘤之间存在关联。在本研究中，我们试图通过将健康保险状况作为社会经济地位的替代指标来间接验证这些发现。
德国有两种类型的健康保险：法定保险和私人保险。由于相关规定，低收入和中等收入居民通常参加法定保险，而高收入居民可以选择购买私人保险。我们将我院患有脑恶性肿瘤的私人保险患者的频率与其他神经外科患者以及德国人群中的相应频率进行了比较。为了校正年龄、性别和距离医院的远近，我们将这些变量作为预测因素纳入逻辑回归和二项式回归。
发现健康保险状况与脑肿瘤之间存在显著关联（优势比[OR]=1.59，CI=1.45-1.74，P<.001）。该关联与患者的性别或年龄无关。虽然私人保险患者通常来自更远的地方，但脑肿瘤患者未观察到这种关系。比较门诊和住院的脑肿瘤患者，未发现我方存在选择偏倚。
先前的研究发现，收入较高、教育水平较高或社会经济地位较高的人患恶性脑肿瘤的可能性更大。我们的研究结果与这些研究一致。虽然这种关联背后的原因尚不清楚，但我们的结果是由数据中的某些随机效应导致的可能性极低。
