Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
Support Care Cancer. 2022 Nov;30(11):9233-9241. doi: 10.1007/s00520-022-07346-2. Epub 2022 Sep 3.
This study investigated the relationship between medical service use and healthcare vulnerability, pre- and post-gastric cancer diagnosis. Differences between healthcare-vulnerable and healthcare-nonvulnerable regions identified inequities that require intervention.
This cohort study was done using the National Health Insurance claims data of patients diagnosed with gastric cancer between 2004 and 2013. The Position Value for Relative Comparison Index was used to determine whether the patients lived in a healthcare-vulnerable region. Medical service use was classified into annual outpatient treatment, hospitalization days, and emergency treatment. We used a generalized linear model to which the Poisson distribution was applied and compared regional differences in medical service use.
A total of 1797 gastric cancer patients who had survived 5 years post-diagnosis were included in the study, of which 14.2% lived in healthcare-vulnerable regions. The patients in vulnerable regions surviving 5-7 years post-diagnosis had a higher number of outpatient visits than those in nonvulnerable regions. Furthermore, hospitalization days were lesser for patients in vulnerable regions who survived 6 years post-diagnosis than those in nonvulnerable regions; however, this number increased in the seventh year.
Our results suggest that gastric cancer survivors living in healthcare-vulnerable regions have a higher probability of increased medical service use 5 years post-diagnosis compared with patients in nonvulnerable regions, which may significantly increase healthcare disparities over time. Therefore, in the future, additional research is needed to elucidate the causes of the disparities in healthcare use and the results of the differences in health outcomes.
本研究调查了胃癌诊断前后医疗服务使用与医疗脆弱性之间的关系。确定医疗脆弱地区与非脆弱地区之间的差异，揭示了需要干预的不平等现象。
本队列研究使用了 2004 年至 2013 年间被诊断患有胃癌的患者的国家健康保险索赔数据。采用位置价值相对比较指数来确定患者是否居住在医疗脆弱地区。医疗服务使用分为年度门诊治疗、住院天数和急诊治疗。我们使用广义线性模型，应用泊松分布来比较医疗服务使用的地区差异。
共纳入了 1797 名在诊断后存活 5 年的胃癌患者，其中 14.2%居住在医疗脆弱地区。在诊断后 5-7 年存活的脆弱地区患者的门诊就诊次数多于非脆弱地区患者。此外，在诊断后 6 年存活的脆弱地区患者的住院天数少于非脆弱地区患者；然而，这一数字在第 7 年增加。
我们的研究结果表明，与非脆弱地区的患者相比，居住在医疗脆弱地区的胃癌幸存者在诊断后 5 年更有可能增加医疗服务的使用，这可能会随着时间的推移显著增加医疗保健方面的差异。因此，未来需要进一步研究，阐明医疗服务使用差异的原因以及健康结果差异的结果。
