Chohan Karan L, Abeykoon Jithma P, Ansell Stephen M, Gertz Morie A, Kapoor Prashant, Paulus Aneel, Ailawadhi Sikander, Reeder Craig B, Witzig Thomas E, Habermann Thomas M, Lacy Martha Q, Kyle Robert A, Go Ronald S, Paludo Jonas
Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Leuk Lymphoma. 2022 Dec;63(12):2879-2888. doi: 10.1080/10428194.2022.2102623. Epub 2022 Jul 23.
Considerable healthcare resource utilization and financial burden have been associated with the treatment of WM; however, the impact of health insurance status on outcomes has not been previously reported. We conducted a National Cancer Database analysis of newly diagnosed cases of active WM between 2004 and 2017 to evaluate the impact of insurance status on outcomes. For patients <65 years old ( = 1249, male sex: 62.4%, median age: 58 years), significant insurance-based survival differences were observed on multivariable analysis; patients who were uninsured [ = 63; HR 3.11 (95%CI, 1.77-5.45), < 0.001], on Medicaid [ = 87; HR 1.88 (95% CI, 1.01-3.48), = 0.045], or on Medicare [ = 122; HR 2.78 (95%CI, 1.76-4.38), < 0.001], had inferior survival compared to patients with private insurance ( = 977; reference). In patients ≥65 years, no insurance-based survival differences were found ( = 0.10). Overall, significant insurance-based outcome disparities exist in WM. Further work is desperately needed to systematically uncover and address these disparities.
华氏巨球蛋白血症（WM）的治疗耗费了大量医疗资源并带来了沉重的经济负担；然而，此前尚无关于健康保险状况对治疗结果影响的报道。我们对2004年至2017年间新诊断的活动性WM病例进行了一项国家癌症数据库分析，以评估保险状况对治疗结果的影响。对于年龄小于65岁的患者（n = 1249，男性占62.4%，中位年龄58岁），多变量分析显示基于保险的生存率存在显著差异；未参保患者（n = 63；HR 3.11，95%CI为1.77 - 5.45，P < 0.001）、参加医疗补助计划的患者（n = 87；HR 1.88，95%CI为1.01 - 3.48，P = 0.045）或参加医疗保险的患者（n = 122；HR 2.78，95%CI为1.76 - 4.38，P < 0.001）与有私人保险的患者（n = 977；作为对照）相比，生存率较低。在65岁及以上的患者中，未发现基于保险的生存率差异（P = 0.10）。总体而言，WM存在基于保险的显著治疗结果差异。迫切需要进一步开展工作，以系统地发现并解决这些差异。
