Department of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.
Department of Medicine, University of Alberta, Edmonton, Canada.
J Otolaryngol Head Neck Surg. 2023 Apr 18;52(1):26. doi: 10.1186/s40463-022-00608-3.
Insurance status has been shown to impact survival outcomes. We sought to determine whether insurance affects the choice of treatment modality among patients with advanced (T4) oral cavity squamous cell carcinoma.
This is a retrospective, population-based cohort study using the Survival, Epidemiology, and End Results Program database. The population included all adult (age ≥ 18) patients with advanced (T4a or T4b) oral cavity squamous cell carcinoma diagnosed from 2007 to 2016. The main outcome was the odds of receiving definitive treatment, defined as primary surgical resection. Insurance status was categorized into uninsured, any Medicaid, and insured groups. Univariable, multivariable, and subgroup analyses were performed.
The study population consisted of 2628 patients, of whom 1915 (72.9%) were insured, 561 (21.3%) had Medicaid, and 152 (5.8%) were uninsured. The multivariable model showed that patients who were 80 years or older, unmarried, received treatment in the pre-Affordable Care Act (ACA) period, and who were on Medicaid or uninsured were significantly less likely to receive definitive treatment. Insured patients were significantly more likely to receive definitive treatment compared to those on Medicaid or uninsured (OR = 0.59, 95% CI 0.46-0.77, p < 0.0001 [Medicaid vs. Insured]; and OR = 0.48, 95% CI 0.31-0.73 p = 0.001 [Uninsured vs. Insured]), however these differences did not persist when considering only those patients treated following the 2014 expansion of the ACA.
Insurance status is significantly associated with treatment modality among adults with advanced stage (T4a) oral cavity squamous cell carcinoma. These findings support the premise of expanding insurance coverage in the US.
保险状况已被证明会影响生存结果。我们旨在确定保险是否会影响晚期（T4）口腔鳞状细胞癌患者的治疗方式选择。
这是一项使用生存、流行病学和结局综合数据库的回顾性、基于人群的队列研究。该人群包括所有 2007 年至 2016 年期间被诊断为晚期（T4a 或 T4b）口腔鳞状细胞癌的成年（年龄≥18 岁）患者。主要结局是接受确定性治疗的可能性，定义为原发性手术切除。保险状况分为无保险、任何医疗补助和有保险群体。进行了单变量、多变量和亚组分析。
研究人群包括 2628 例患者，其中 1915 例（72.9%）有保险，561 例（21.3%）有医疗补助，152 例（5.8%）无保险。多变量模型显示，80 岁或以上、未婚、在平价医疗法案（ACA）前接受治疗以及有医疗补助或无保险的患者接受确定性治疗的可能性显著较低。与有医疗补助或无保险的患者相比，有保险的患者接受确定性治疗的可能性显著更高（OR=0.59，95%CI 0.46-0.77，p<0.0001[医疗补助与保险]；OR=0.48，95%CI 0.31-0.73，p=0.001[无保险与保险]），但在仅考虑 2014 年 ACA 扩大后接受治疗的患者时，这些差异并不存在。
保险状况与晚期（T4a）口腔鳞状细胞癌成人患者的治疗方式显著相关。这些发现支持在美国扩大保险覆盖范围的前提。
