School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
Center for Global Health, Nanjing Medical University, Nanjing, China.
Front Public Health. 2022 Aug 2;10:942911. doi: 10.3389/fpubh.2022.942911. eCollection 2022.
Cancer is a major public health problem worldwide and the leading cause of death in China, with increasing incidence and mortality rates. This study sought to assess socioeconomic-related inequalities in health care use among cancer patients in China and to analyze factors associated with this disparity.
This study used data collected for the China Health and Retirement Longitudinal Study in 2018. Patients who reported having cancer were included. The annual per capita household expenditure was classified into five groups by the quintile method. We calculated the distribution of actual, need-predicted, and need-standardized health care use across different socioeconomic groups among patients with cancer. The concentration index (CI) was used to evaluate inequalities in health care use. Influencing factors of inequalities were measured with the decomposition method.
A total of 392 people diagnosed with cancer were included in this study. The proportion of cancer patients who utilized outpatient and inpatient services was 23.47% and 40.82%, respectively, and the CIs for actual outpatient and inpatient service use were 0.1419 and 0.1960. The standardized CIs (CI for outpatient visits = 0.1549; CI for inpatient services = 0.1802) were also both positive, indicating that affluent cancer patients used more health services. The annual per capita household expenditure was the greatest factor favoring the better-off, which contributed as much as 78.99% and 83.92% to the inequality in outpatient and inpatient services use, followed by high school education (26.49% for outpatient services) and living in a rural village (34.53% for inpatient services). Urban Employee Basic Medical Insurance exacerbated the inequality in inpatient services (21.97%) while having a negative impact on outpatient visits (-22.19%).
There is a pro-rich inequality in outpatient and inpatient services use among cancer patients in China. A lower socioeconomic status is negatively associated with cancer care use. Hence, more targeted financial protection for poor people would relieve cancer patients of the burden caused by the high cost of cancer care.
癌症是全球重大公共卫生问题，也是中国的主要死亡原因，其发病率和死亡率呈上升趋势。本研究旨在评估中国癌症患者卫生保健利用的社会经济相关不平等，并分析导致这种差异的因素。
本研究使用了 2018 年中国健康与养老追踪调查的数据。纳入报告患有癌症的患者。采用五分位法将患者的家庭人均年支出分为五组。我们计算了不同社会经济群体中癌症患者实际、需求预测和需求标准化卫生保健利用的分布。使用集中指数（CI）评估卫生保健利用的不平等程度。使用分解法衡量不平等的影响因素。
本研究共纳入 392 名确诊癌症患者。癌症患者门诊和住院服务利用率分别为 23.47%和 40.82%，实际门诊和住院服务利用的 CI 分别为 0.1419 和 0.1960。标准化 CI（门诊就诊 CI = 0.1549；住院服务 CI = 0.1802）也均为正值，表明富裕的癌症患者使用了更多的卫生服务。家庭人均年支出是有利于富人的最大因素，对门诊和住院服务利用不平等的贡献分别高达 78.99%和 83.92%，其次是高中教育（门诊服务 26.49%）和居住在农村地区（住院服务 34.53%）。城镇职工基本医疗保险加剧了住院服务的不平等（21.97%），同时对门诊就诊产生负面影响（-22.19%）。
中国癌症患者门诊和住院服务利用存在贫富不均。较低的社会经济地位与癌症护理利用呈负相关。因此，对贫困人口进行更有针对性的经济保护，可以减轻癌症患者因癌症护理费用高而带来的负担。
