Coughlin Steven S, Datta Biplab, Williams Lovoria B, Bevel Malcolm, Cortes Jorge E
Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA.
Institute of Public and Preventive Health, Augusta University, Augusta, GA.
JCO Oncol Pract. 2022 Nov;18(11):e1831-e1838. doi: 10.1200/OP.22.00152. Epub 2022 Sep 6.
There has been increasing concern over the high cost of oncology care and its long-lasting impact on the well-being of cancer survivors.
We examined characteristics of impoverished cancer survivors in the United States, including their physical and mental health, using data from the 2020 Behavioral Risk Factor Surveillance System. We used binomial logistic regressions for binary outcome variables, and negative binomial regressions for count variables, to estimate the odds ratios (ORs) and incident rate ratios (IRRs) of the physical, mental, and socioeconomic-related health factors for low-income cancer survivors versus higher-income survivors. We compared the ORs and IRRs for low-income cancer survivors with those of higher income cancer survivors.
There was a two-fold increased odds (adjusted OR, 2.33; 95% CI, 1.86 to 2.91) of having fair/poor health for low-income cancer survivors compared with higher-income cancer survivors. There was an almost two-fold increased odds (adjusted OR, 1.97; 95% CI, 1.50 to 2.59) of not being able to see a doctor among low-income cancer survivors, and a 42% lower odds (adjusted OR, 0.58; 95% CI, 0.39 to 0.86) of having health insurance coverage for low-income cancer survivors compared with higher-income survivors. Incidence rate ratios for physical (IRR, 1.52; 95% CI, 1.31 to 1.75) and mental (IRR, 1.53; 95% CI, 1.26 to 1.86) unhealthy days were significantly higher among low-income cancer survivors compared with nonpoor cancer survivors.
Strategies are available to ameliorate financial hardship at multiple levels. Implementation of these strategies is urgently needed.
人们越来越关注肿瘤治疗的高昂成本及其对癌症幸存者幸福感的长期影响。
我们利用2020年行为风险因素监测系统的数据，研究了美国贫困癌症幸存者的特征，包括他们的身心健康状况。对于二元结果变量，我们使用二项逻辑回归；对于计数变量，我们使用负二项回归，以估计低收入癌症幸存者与高收入幸存者在身体、心理和社会经济相关健康因素方面的优势比（OR）和发病率比（IRR）。我们比较了低收入癌症幸存者与高收入癌症幸存者的OR和IRR。
与高收入癌症幸存者相比，低收入癌症幸存者健康状况为“一般/较差”的几率增加了两倍（调整后的OR为2.33；95%置信区间为1.86至2.91）。低收入癌症幸存者中无法看医生的几率增加了近两倍（调整后的OR为1.97；95%置信区间为1.50至2.59），与高收入幸存者相比，低收入癌症幸存者拥有医疗保险的几率降低了42%（调整后的OR为0.58；95%置信区间为0.39至0.86）。与非贫困癌症幸存者相比，低收入癌症幸存者身体不健康天数（IRR为1.52；95%置信区间为1.31至1.75）和心理不健康天数（IRR为1.53；95%置信区间为1.26至1.86）的发病率比显著更高。
有多种策略可用于缓解多个层面的经济困难。迫切需要实施这些策略。
