Institute of Economics.
The Bureau of Jiangyin Human Resources and Social Security, Jiangyin.
J Pediatr Hematol Oncol. 2022 Mar 1;44(2):e403-e412. doi: 10.1097/MPH.0000000000002314.
Impacts of health insurance status on survival outcomes among adolescent and young adult (AYA, 15 to 39 years of age) patients with lymphoma in the United States are insufficiently known. This study aimed to clarify associations between health insurance status and overall survival (OS) estimates in this population.
We examined 18 Surveillance, Epidemiology, and End Results registries in the United States and analyzed American AYA patients with lymphoma diagnosed during January 2007 and December 2016. Health insurance status was categorized, and Kaplan-Meier and multifactor Cox regressions were adopted using hazard ratio and 95% confidence interval. Probable baseline confounding was modulated by multiple propensity score.
A total of 21,149 patients were considered; ~28% were 18 to 25 years old, and 63.5% and 7.5% had private and no insurance, respectively. Private insurance rates increased in the 18 to 25 age group (60.1% to 6.1%, P<0.001) following the 2010 Patient Protection and Affordable Care Act (ACA), and lymphoma survival rates improved slightly 1 to 5 years postdiagnosis. Five-year OS rates decreased with age (93.9%, 90.4%, and 87.0% at 15 to 17, 18 to 25, and 26 to 39, respectively) and differed among insurance conditions (81.7%, 79.2%, 89.2%, and 92.0% for uninsured, Medicaid, insured, and insured/no specifics, respectively). Risk of death was significantly higher for those with Medicaid or no insurance than for those with private insurance in multiple propensity score-adjusted models (hazard ratio [95% confidence interval]=1.07 [1.03-1.12]), independent of stage at diagnosis.
No or insufficient insurance was linked to poor OS in our sample in exposure-outcome association analysis. Insurance coverage and health care availability may enhance disparate outcomes of AYAs with cancer. The ACA has improved insurance coverage and survival rates for out sample. Nevertheless, strategies are needed to identify causality and eliminate disparities.
在美国，青少年和年轻成人（AYA，15 至 39 岁）淋巴瘤患者的健康保险状况对生存结果的影响尚不清楚。本研究旨在阐明这一人群的健康保险状况与总生存（OS）估计之间的关联。
我们检查了美国的 18 个监测、流行病学和最终结果登记处，并分析了 2007 年 1 月至 2016 年 12 月期间诊断为淋巴瘤的美国 AYA 患者。健康保险状况进行了分类，并采用风险比和 95%置信区间进行了 Kaplan-Meier 和多因素 Cox 回归。通过多倾向评分调节可能的基线混杂。
共考虑了 21149 例患者；约 28%为 18 至 25 岁，分别有 63.5%和 7.5%有私人保险和无保险。自 2010 年《患者保护与平价医疗法案》（ACA）以来，18 至 25 岁年龄组的私人保险率有所增加，诊断后 1 至 5 年淋巴瘤生存率略有提高。5 年 OS 率随年龄下降（15 至 17、18 至 25 和 26 至 39 岁时分别为 93.9%、90.4%和 87.0%），且在不同保险条件下存在差异（分别为 81.7%、79.2%、89.2%和 92.0%为无保险、医疗补助、有保险和有保险/无具体规定）。在多个倾向评分调整模型中，与私人保险相比，拥有医疗补助或无保险的患者死亡风险显著更高（风险比[95%置信区间]=1.07[1.03-1.12]），与诊断时的分期无关。
在我们的样本中，无保险或保险不足与不良 OS 相关，这表明在暴露-结果关联分析中存在关联。保险覆盖范围和医疗保健的可及性可能会改善 AYA 癌症患者的不同结局。ACA 已经提高了我们样本的保险覆盖范围和生存率。然而，需要制定策略来确定因果关系并消除差异。
