Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA.
Health ResearchTx, Trevose, PA 19053, USA.
Mil Med. 2023 Nov 8;188(Suppl 6):494-502. doi: 10.1093/milmed/usad218.
The Military Health System (MHS) is a universal health care system, in which health care disparities are theoretically minimized. This study aimed to identify disparities and assess their impact on the initiation of timely treatment for breast cancer within a universally insured population.
A retrospective cohort study was performed to evaluate the treatment of female breast cancer patients ≥18 years of age within the MHS from January 1, 2014, to December 31, 2018. Incident breast cancer was defined as ≥2 breast cancer diagnoses without a prior diagnosis of breast cancer during the three continuous years before index diagnosis. Time from index diagnosis to initial treatment was calculated and dichotomized as receiving treatment within a clinically acceptable time course. Poisson regression was used to estimate relative risk (RR) with 95% CIs.
Among the 30,761 female breast cancer patients identified in the MHS, only 6% of patients had a prolonged time to initial treatment. Time to initial treatment decreased during the study period from a mean (SD) of 63.2 (152.0) days in 2014 to 37.1 (28.8) days in 2018 (P < 0.0001). Age, region, and military characteristics remained significantly associated with receiving timely treatment even after the adjustment of confounders. Patients 70-79 years old were twice as likely as 18-39 years olds to receive timely treatment (RR: 2.0100, 95% CI, 1.52-2.6563, P < 0.0001). Senior officers and their dependents were more likely to receive timely initial treatment compared to junior enlisted patients and their dependents (RR: 1.5956, 95% CI, 1.2119-2.1005, P = 0.004).
There have been significant improvements in the timely initiation of breast cancer treatment within the MHS. However, demographic and socioeconomic disparities can be identified that affect the timely initiation of therapy.
军人健康系统（MHS）是一种全民健康保障体系，理论上，该体系下的医疗保健差距最小化。本研究旨在确定差距，并评估其对全民保险人群中乳腺癌及时治疗启动的影响。
本研究采用回顾性队列研究方法，评估 2014 年 1 月 1 日至 2018 年 12 月 31 日期间 MHS 内≥18 岁女性乳腺癌患者的治疗情况。乳腺癌新发定义为在指数诊断前的连续 3 年内≥2 次乳腺癌诊断，且无先前乳腺癌诊断。从指数诊断到初始治疗的时间计算并分为在临床可接受的时间范围内接受治疗和未在临床可接受的时间范围内接受治疗。采用泊松回归估计相对风险（RR）及其 95%置信区间（CI）。
在 MHS 中确定的 30761 例女性乳腺癌患者中，仅有 6%的患者初始治疗时间延长。在研究期间，初始治疗时间从 2014 年的平均（SD）63.2（152.0）天缩短至 2018 年的 37.1（28.8）天（P<0.0001）。即使在调整了混杂因素后，年龄、地区和军事特征仍然与及时治疗显著相关。70-79 岁的患者接受及时治疗的可能性是 18-39 岁患者的两倍（RR：2.0100，95%CI，1.52-2.6563，P<0.0001）。与初级入伍患者及其家属相比，高级军官及其家属更有可能接受及时的初始治疗（RR：1.5956，95%CI，1.2119-2.1005，P=0.004）。
MHS 中乳腺癌治疗的及时启动有了显著改善。然而，仍存在影响治疗及时启动的人口统计学和社会经济差异。
