按医疗补助状况划分的原发性胰腺腺癌生存差异：一项全国基于人群的风险分析。

Disparities in primary pancreatic adenocarcinoma survival by Medicaid-status: A national population-based risk analysis.

机构信息

Roger Williams Medical Center, Division of Surgical Oncology, Providence, RI, USA.

Massachusetts Institute of Technology, Department of Computer Science, Cambridge, MA, USA.

出版信息

Eur J Surg Oncol. 2023 Jul;49(7):1242-1249. doi: 10.1016/j.ejso.2023.02.002. Epub 2023 Feb 13.

DOI:10.1016/j.ejso.2023.02.002

PMID:36801151

Abstract

BACKGROUND

Pancreatic adenocarcinoma (PAC) has one of the highest mortality rates among all malignancies. While previous research has analyzed socioeconomic factors' effect on PAC survival, outcomes of Medicaid patients are understudied.

METHODS

Using the SEER-Medicaid database, we studied non-elderly, adult patients with primary PAC diagnosed between 2006 and 2013. Five-year disease-specific survival analysis was performed using the Kaplan-Meier method and adjusted analysis using Cox proportional-hazards regression.

RESULTS

Among 15,549 patients (1799 Medicaid, 13,750 non-Medicaid), Medicaid patients were less likely to receive surgery (p < .001) and more likely to be non-White (p < .001). The 5-year survival of non-Medicaid patients (8.13%, 274 days [270-280]) was significantly higher than that of Medicaid patients (4.97%, 152 days, [151-182], p < .001). Among Medicaid patients, those in high poverty areas had significantly lower survival rates (152 days [122-154]) than those in medium poverty areas (182 days [157-213], p = .008). However, non-White (152 days [150-182]) and White Medicaid patients (152 days [150-182]) had similar survival (p = .812). On adjusted analysis, Medicaid patients were still associated with a significantly higher risk of mortality (aHR 1.33 [1.26-1.41], p < .0001) compared to non-Medicaid patients. Unmarried status and rurality were associated with a higher risk of mortality (p < .001).

DISCUSSION

Medicaid enrollment prior to PAC diagnosis was generally associated with a higher risk of disease-specific mortality. While there was no difference in the survival between White and non-White Medicaid patients, Medicaid patients living in high poverty areas were shown to be associated with poor survival.

摘要

背景

胰腺癌（PAC）是所有恶性肿瘤中死亡率最高的肿瘤之一。虽然之前的研究已经分析了社会经济因素对 PAC 生存的影响，但 Medicaid 患者的结果仍研究不足。

方法

我们使用 SEER-Medicaid 数据库，研究了 2006 年至 2013 年间诊断为原发性 PAC 的非老年成年患者。采用 Kaplan-Meier 方法进行 5 年疾病特异性生存分析，并采用 Cox 比例风险回归进行调整分析。

结果

在 15549 名患者（1799 名 Medicaid 患者，13750 名非 Medicaid 患者）中， Medicaid 患者接受手术的可能性较小（p<0.001），而非白人的可能性较大（p<0.001）。非 Medicaid 患者的 5 年生存率（8.13%，274 天[270-280]）明显高于 Medicaid 患者（4.97%，152 天，[151-182]，p<0.001）。在 Medicaid 患者中，高贫困地区的生存率明显较低（152 天[122-154]），而中等贫困地区的生存率较高（182 天[157-213]，p=0.008）。然而，非白人（152 天[150-182]）和白人 Medicaid 患者（152 天[150-182]）的生存率相似（p=0.812）。在调整分析中， Medicaid 患者的死亡风险仍然明显高于非 Medicaid 患者（aHR 1.33[1.26-1.41]，p<0.0001）。未婚状态和农村地区与更高的死亡风险相关（p<0.001）。