Dhakal Prajwal, Joshi Utsav, Lyden Elizabeth, Pyakuryal Avantika, Gundabolu Krishna, Bhatt Vijaya Raj
Division of Hematology, Oncology, and Blood & Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.
Leuk Lymphoma. 2022 Nov;63(11):2627-2635. doi: 10.1080/10428194.2022.2090554. Epub 2022 Jun 23.
Understanding the association between insurance status and survival in an evolving US healthcare system remains a challenge but is essential to address healthcare disparities. We utilized National Cancer Database to evaluate the effects of insurance type on one-month mortality and overall survival (OS) in patients with acute promyelocytic leukemia. Among patients <65 years, one-month mortality was worse for uninsured patients and patients with Medicare compared to patients with private insurance. OS was similar between patients with private insurance and uninsured patients but worse for patients with Medicare and Medicaid/other government insurance. In multivariate analysis, older age and greater comorbidity burden conferred worse OS. For patients ≥65 years, insurance type did not affect one-month mortality and OS. Older age, greater comorbidity burden, and treatment at non-academic centers conferred worse one-month mortality and OS. Our results highlight healthcare disparities based on insurance types for both younger and older patients.
在美国不断发展的医疗体系中，理解保险状况与生存之间的关联仍然是一项挑战，但对于解决医疗保健差异至关重要。我们利用国家癌症数据库评估保险类型对急性早幼粒细胞白血病患者1个月死亡率和总生存期（OS）的影响。在年龄小于65岁的患者中，与有私人保险的患者相比，未参保患者和医疗保险患者的1个月死亡率更高。有私人保险的患者和未参保患者的总生存期相似，但医疗保险和医疗补助/其他政府保险患者的总生存期更差。在多变量分析中，年龄较大和合并症负担较重会导致总生存期较差。对于65岁及以上的患者，保险类型不影响1个月死亡率和总生存期。年龄较大、合并症负担较重以及在非学术中心接受治疗会导致1个月死亡率和总生存期更差。我们的结果凸显了基于保险类型的年轻和老年患者的医疗保健差异。
