School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
Front Public Health. 2021 Nov 5;9:742355. doi: 10.3389/fpubh.2021.742355. eCollection 2021.
Health disparities related to basic medical insurance in China have not been sufficiently examined, particularly among patients with hepatocellular carcinoma (HCC). This study aims to investigate the disparities in HCC survival by insurance status in Tianjin, China. This retrospective analysis used data from the Tianjin Basic Medical Insurance claims database, which consists of enrollees covered by Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Resident Basic Medical Insurance (URRBMI). Adult patients newly diagnosed with HCC between 2011 and 2016 were identified and followed until death from any cause, withdrawal from UEBMI or URRBMI, or the latest data in the dataset (censoring as of December 31st 2017), whichever occurred first. Patients' overall survival during the follow-up was assessed using Kaplan-Meier and extrapolated by six parametric models. The hazard ratio (HR) and 95% confidence intervals (CI) were calculated with the adjusted Cox proportional hazards model including age at diagnosis, sex, baseline comorbidities and complications, baseline healthcare resources utilization and medical costs, tumor metastasis at diagnosis, the initial treatment after diagnosis and antiviral therapy during the follow-up. Two thousand sixty eight patients covered by UEBMI ( = 1,468) and URRBMI ( = 570) were included (mean age: 60.6 vs. 60.9, = 0.667; female: 31.8 vs. 27.7%, = 0.074). The median survival time for patients within the UEBMI and URRBMI were 37.8 and 12.2 months, and the 1-, 3-, 5-, 10-year overall survival rates were 63.8, 50.2, 51.0, 33.4, and 44.4, 22.8, 31.5, 13.1%, respectively. Compared with UEBMI, patients covered by URRBMI had 72% (HR: 1.72; 95% CI: 1.47-2.00) higher risk of death after adjustments for measured confounders above. The survival difference was still statistically significant (HR: 1.49; 95% CI: 1.21-1.83) in sensitivity analysis based on propensity score matching. This study reveals that HCC patients covered by URRBMI may have worse survival than patients covered by UEBMI. Further efforts are warranted to understand healthcare disparities for patients covered by different basic medical insurance in China.
在中国，与基本医疗保险相关的健康差异尚未得到充分研究，尤其是在肝细胞癌（HCC）患者中。本研究旨在探讨天津市不同医疗保险类型对 HCC 患者生存的影响。
本回顾性分析使用了天津市基本医疗保险理赔数据库的数据，该数据库包含城镇职工基本医疗保险（UEBMI）和城乡居民基本医疗保险（URRBMI）的参保人员。纳入 2011 年至 2016 年期间新诊断为 HCC 的成年患者，随访至任何原因死亡、退出 UEBMI 或 URRBMI 或数据库中最新数据（截止日期为 2017 年 12 月 31 日，以先发生者为准）。使用 Kaplan-Meier 法评估患者随访期间的总生存率，并通过 6 个参数模型进行外推。使用调整后的 Cox 比例风险模型计算调整年龄、性别、基线合并症和并发症、基线医疗资源利用和医疗费用、诊断时肿瘤转移、诊断后初始治疗和随访期间抗病毒治疗后，计算风险比（HR）和 95%置信区间（CI）。
共纳入 2068 名 UEBMI（n=1468）和 URRBMI（n=570）患者（平均年龄：60.6 岁 vs. 60.9 岁，=0.667；女性：31.8% vs. 27.7%，=0.074）。UEBMI 和 URRBMI 患者的中位生存时间分别为 37.8 个月和 12.2 个月，1、3、5、10 年总生存率分别为 63.8%、50.2%、51.0%、33.4%和 44.4%、22.8%、31.5%、13.1%。与 UEBMI 相比，校正上述测量混杂因素后，URRBMI 覆盖的患者死亡风险增加 72%（HR：1.72；95%CI：1.47-2.00）。基于倾向评分匹配的敏感性分析结果仍具有统计学意义（HR：1.49；95%CI：1.21-1.83）。
本研究表明，URRBMI 覆盖的 HCC 患者的生存可能比 UEBMI 覆盖的患者差。需要进一步努力了解中国不同基本医疗保险覆盖人群的医疗保健差异。
