Price Meghan J, De la Garza Ramos Rafael, Dalton Tara, McCray Edwin, Pennington Zach, Erickson Melissa, Walsh Kyle M, Yassari Reza, Sciubba Daniel M, Goodwin Andrea N, Goodwin C Rory
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Cancer Epidemiol. 2022 Feb;76:102073. doi: 10.1016/j.canep.2021.102073. Epub 2021 Nov 30.
It is well established that insurance status is a mediator of disease management, treatment course, and clinical outcomes in cancer patients. Our study assessed differences in clinical presentation, treatment course, mortality rates, and in-hospital complications for patients admitted to the hospital with late-stage cancer - specifically, metastatic spine disease (MSD), by insurance status.
The United States National Inpatient Sample (NIS) database (2012-2014) was queried to identify patients with visceral metastases, metastatic spinal cord compression (MSCC) or pathological fracture of the spine in the setting of cancer. Clinical presentation, type of intervention, mortality rates, and in-hospital complications were compared amongst patients by insurance coverage (Medicare, Medicaid, commercial or unknown). Multivariable logistical regression and age sensitivity analyses were performed.
A total of 48,560 MSD patients were identified. Patients with Medicaid coverage presented with significantly higher rates of MSCC (p < 0.001), paralysis (0.008), and visceral metastases (p < 0.001). Patients with commercial insurance were more likely to receive surgical intervention (OR 1.43; p < 0.001). Patients with Medicaid < 65 had higher rates of prolonged length of stay (PLOS) (OR 1.26; 95% CI, 1.01-1.55; p = 0.040) while both Medicare and Medicaid patients < 65 were more likely to have non-routine discharges. In-hospital mortality rates were significantly higher for patients with Medicaid (OR 2.66; 95% CI 1.20-5.89; p = 0.016) and commercial insurance (OR 1.58; 95% CI 1.09-2.27;p = 0.013) older than 65.
Given the differing severity in MSD presentation, mortality rates, and rates of PLOS by insurance status, our results identify disparities based on insurance coverage.
保险状况是癌症患者疾病管理、治疗过程和临床结局的一个调节因素，这一点已得到充分证实。我们的研究评估了因保险状况，晚期癌症患者（特别是转移性脊柱疾病，MSD）入院时在临床表现、治疗过程、死亡率和院内并发症方面的差异。
查询美国国家住院患者样本（NIS）数据库（2012 - 2014年），以识别患有内脏转移、转移性脊髓压迫（MSCC）或癌症背景下脊柱病理性骨折的患者。按保险覆盖类型（医疗保险、医疗补助、商业保险或未知）对患者的临床表现、干预类型、死亡率和院内并发症进行比较。进行了多变量逻辑回归和年龄敏感性分析。
共识别出48560例MSD患者。有医疗补助覆盖的患者出现MSCC的比例显著更高（p < 0.001）、瘫痪比例（p = 0.008）和内脏转移比例（p < 0.001）。有商业保险的患者更有可能接受手术干预（OR 1.43；p < 0.001）。65岁以下有医疗补助的患者住院时间延长（PLOS）的比例更高（OR 1.26；95% CI，1.01 - 1.55；p = 0.040），而65岁以下的医疗保险和医疗补助患者更有可能非常规出院。65岁以上有医疗补助（OR 2.66；95% CI 1.20 - 5.89；p = 0.016）和商业保险（OR 1.58；95% CI 1.09 - 2.27；p = 0.013）的患者院内死亡率显著更高。
鉴于MSD在临床表现、死亡率和PLOS发生率方面因保险状况而异，我们的结果确定了基于保险覆盖的差异。
