Institute of Economics, Shanghai Academy of Social Sciences, Shanghai, China.
The Bureau of Jiangyin Human Resources and Social Security, Jiangyin, Jiangsu, China.
Acta Haematol. 2021;144(5):542-550. doi: 10.1159/000514671. Epub 2021 Mar 30.
BACKGROUND/AIM: The impacts of health insurance status on survival outcomes in multiple myeloma (MM) have not been addressed in depth. The present study was conducted to identify definite relationships of cancer-specific survival (CSS) and overall survival (OS) with health insurance status in MM patients.
MM patients aged 18-64 years and with complete insurance records between January 1, 2007, and December 31, 2016, were identified from 18 Surveillance, Epidemiology, and End Results (SEER) Database registries. Health insurance condition was categorized as uninsured, any Medicaid, insured, and insured (no specifics). Relationships of health insurance condition with OS/CSS were identified through Kaplan-Meier, and uni-/multivariate Cox regressions using the hazard ratio and 95% confidence interval. Potential baseline confounding was adjusted using multiple propensity score (mPS).
Totally 17,981 patients were included, including 68.3% with private insurance and only 4.9% with uninsurance. Log-rank test uncovered significant difference between health insurance status and OS/CSS among MM patients. Patients with non-insurance or Medicaid coverage in comparison with private insurance tended to present poorer OS/CSS both in multivariate Cox regression and in mPS-adjusted model (non-insurance vs. private insurance [OS/CSS]: 1.33 [1.20-1.48]/1.13 [1.00-1.28] and 1.45 [1.25-1.69]/1.18 [1.04-1.33], respectively; Medicaid coverage vs. private insurance [OS/CSS]: 1.67 [1.56-1.78]/1.25 [1.16-1.36] and 1.76 [1.62-1.90]/1.23 [1.13-1.35], respectively).
Our observational study of exposure-outcome associations suggests that insufficient or no insurance is moderately linked with OS among MM patients aged 18-64 years. Wide insurance coverage and health-care availability may strengthen some disparate outcomes. In the future, prospective cohort research is needed to further clarify concrete risks with insurance type, owing to the lack of definite division of insurance data in SEER.
背景/目的：医疗保险状况对多发性骨髓瘤（MM）患者生存结果的影响尚未得到深入研究。本研究旨在确定癌症特异性生存（CSS）和总生存（OS）与 MM 患者医疗保险状况之间的明确关系。
从 18 个监测、流行病学和最终结果（SEER）数据库登记处中确定了年龄在 18-64 岁之间且有完整保险记录的 MM 患者，时间范围为 2007 年 1 月 1 日至 2016 年 12 月 31 日。将健康保险状况分为无保险、任何医疗补助、有保险和无具体保险。通过 Kaplan-Meier 以及使用风险比和 95%置信区间的单变量/多变量 Cox 回归，确定健康保险状况与 OS/CSS 的关系。使用多个倾向评分（mPS）调整潜在的基线混杂因素。
共纳入 17981 例患者，其中 68.3%有私人保险，仅有 4.9%无保险。对数秩检验显示，医疗保险状况与 MM 患者的 OS/CSS 之间存在显著差异。与私人保险相比，无保险或医疗补助覆盖的患者在多变量 Cox 回归和 mPS 调整模型中，OS/CSS 较差（无保险与私人保险[OS/CSS]：1.33[1.20-1.48]/1.13[1.00-1.28]和 1.45[1.25-1.69]/1.18[1.04-1.33]；医疗补助覆盖与私人保险[OS/CSS]：1.67[1.56-1.78]/1.25[1.16-1.36]和 1.76[1.62-1.90]/1.23[1.13-1.35]）。
我们对暴露-结果关联的观察性研究表明，18-64 岁 MM 患者中，保险不足或无保险与 OS 中度相关。广泛的保险覆盖和医疗保健可增强某些差异结果。由于 SEER 中缺乏明确的保险数据划分，未来需要前瞻性队列研究来进一步明确具体的保险类型风险。
