Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
World Neurosurg. 2022 Feb;158:e111-e121. doi: 10.1016/j.wneu.2021.10.124. Epub 2021 Oct 20.
Quantitative analysis of the financial hardship faced by patients with brain tumors is lacking. The present study sought to conduct a longitudinal analysis of responses to the National Health Interview Survey by patients diagnosed with brain tumors and characterize the impact of demographic factors on financial hardship indices.
National Health Interview Survey respondents between 1997 and 2018 who reported previous diagnosis with cancer of the brain and who responded to 4 survey questions that assessed financial stress were included. Sociodemographic exposures included age, ethnicity/race, marriage status, insurance status, and degree of highest educational attainment.
Educational attainment, marital status, and insurance status were the most significant risk factors for temporary or indefinite delays to necessary medical care. Those with only a high-school diploma had 9.6 times higher odds (adjusted odds ratio, 9.68; 95% confidence interval, 2.96-31.70; P < 0.001) of reporting that, in the past 12 months, one of their family members had to limit their medical care in an effort to save money. Similarly, patients with brain tumors who were not married had 3.94 times greater odds (adjusted odds ratio, 3.94; 95% confidence interval, 1.49-10.44; P = 0.009) of avoiding necessary medical care because of an inability to afford it.
Given this variation in self-reported financial burden, demographics clearly have an impact on a patient's holistic experience after a brain cancer diagnosis. Therefore, by using the comparisons in this study, we hope that medical institutions and neurosurgical societies can more accurately predict which patients are most susceptible to significant financial stress and distribute resources accordingly.
缺乏对脑瘤患者所面临经济困难的定量分析。本研究旨在对诊断为脑瘤的患者进行全国健康访谈调查（National Health Interview Survey，NHIS）应答的纵向分析，并描述人口统计学因素对经济困难指数的影响。
纳入了 1997 年至 2018 年期间在 NHIS 调查中报告过脑部癌症既往诊断且对 4 个评估经济压力的调查问题作出应答的患者。社会人口学暴露因素包括年龄、种族/民族、婚姻状况、保险状况和最高教育程度。
教育程度、婚姻状况和保险状况是导致暂时或无限期推迟必要医疗的最重要危险因素。仅具有高中文凭的患者报告在过去 12 个月中，其家庭成员为省钱而限制医疗保健的可能性是其他患者的 9.6 倍（调整后比值比，9.68；95%置信区间，2.96-31.70；P<0.001）。同样，由于负担不起费用而避免必要医疗的脑瘤患者，未婚患者的可能性是已婚患者的 3.94 倍（调整后比值比，3.94；95%置信区间，1.49-10.44；P=0.009）。
鉴于自我报告的经济负担存在差异，人口统计学因素显然对脑癌诊断后患者的整体体验有影响。因此，通过使用本研究中的比较，我们希望医疗机构和神经外科学会能够更准确地预测哪些患者最容易受到严重经济压力的影响，并相应地分配资源。
