Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Economics, University of Chicago, Chicago, IL, USA.
JNCI Cancer Spectr. 2023 Aug 31;7(5). doi: 10.1093/jncics/pkad059.
Cancer survivors with a disability are among the most vulnerable in health status and financial hardship, but no prior research has systematically examined how disability modifies health-care use and costs. This study examined the association between functional disability among cancer survivors and their health-care utilization and medical costs.
We generated nationally representative estimates using the 2015-2019 Medical Expenditure Panel Survey. Outcomes included use of 6 service types (inpatient, outpatient, office-based physician, office-based nonphysician, emergency department, and prescription) and medical costs of aggregate services and by each of 6 service types. The primary independent variable was a categorical variable for the total number of functional disabilities. We employed multivariable generalized linear models and 2-part models, adjusting for sociodemographics and health conditions and accounting for survey design.
Among cancer survivors (n = 9359; weighted n = 21 046 285), 38.8% reported at least 1 disability. Compared with individuals without a disability, cancer survivors with 4 or more disabilities experienced longer hospital stays (adjusted average marginal effect = 1.14 days, 95% confidence interval [CI] = 0.55 to 1.73), more visits to an office-based physician (average marginal effect = 1.43 visits, 95% CI = 0.51 to 2.35), and a greater number of prescriptions (average marginal effect = 12.1 prescriptions, 95% CI = 9.27 to 15.0). Their total (average marginal effect = $9537, 95% CI = $5713 to $13 361) and out-of-pocket (average marginal effect = $639, 95% CI = $79 to $1199) medical costs for aggregate services were statistically significantly higher. By type, disability in independent living was most strongly associated with greater costs for aggregate services.
Cancer survivors with a disability experienced greater health-care use and higher costs. Cancer survivorship planning for health care and financial stability should consider the patients' disability profile.
在健康状况和经济困难方面，残疾癌症幸存者是最脆弱的群体之一，但尚无研究系统地研究残疾如何改变癌症幸存者的医疗保健使用和成本。本研究调查了癌症幸存者的功能障碍与他们的医疗保健使用和医疗费用之间的关联。
我们使用 2015-2019 年医疗支出面板调查生成了全国代表性估计。结果包括使用 6 种服务类型（住院、门诊、门诊医师、门诊非医师、急诊室和处方）和按每种服务类型汇总的服务和医疗费用。主要自变量是功能障碍总数的分类变量。我们采用多变量广义线性模型和两部分模型，调整了社会人口统计学和健康状况，并考虑了调查设计。
在癌症幸存者中（n=9359；加权 n=21046285），38.8%报告至少有一种残疾。与没有残疾的个体相比，有 4 种或更多残疾的癌症幸存者住院时间更长（调整后的平均边际效应=1.14 天，95%置信区间[CI] =0.55 至 1.73），就诊次数更多医生（平均边际效应=1.43 次就诊，95%置信区间[CI] =0.51 至 2.35）和更多的处方（平均边际效应=12.1 张处方，95%置信区间[CI] =9.27 至 15.0）。他们的总（平均边际效应=9537 美元，95%置信区间[CI] =5713 美元至 13361 美元）和自付（平均边际效应=639 美元，95%置信区间[CI] =79 美元至 1199 美元）用于汇总服务的医疗费用具有统计学意义上的显着差异。按类型划分，独立生活的残疾与总服务费用的增加最相关。
有残疾的癌症幸存者的医疗保健利用率更高，费用也更高。癌症生存规划的医疗保健和财务稳定性应考虑患者的残疾状况。
