北卡罗来纳州农村地区长期存活的阿巴拉契亚癌症幸存者中因费用而延迟和放弃治疗的相关因素。
Factors Associated with Delaying and Forgoing Care Due to Cost among Long-term, Appalachian Cancer Survivors in Rural North Carolina.
作者信息
Falk Derek S, Tooze Janet A, Winkfield Karen M, Bell Ronny A, Birken Sarah A, Morris Bonny B, Strom Carla, Copus Emily, Shore Kelsey, Weaver Kathryn E
机构信息
Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157 (Sponsor).
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, Ohio, USA 44106 (Present).
出版信息
Cancer Surviv Res Care. 2023;1(1). doi: 10.1080/28352610.2023.2270401. Epub 2023 Dec 18.
BACKGROUND
Little research exists on delayed and forgone health and mental health care due to cost among rural cancer survivors.
METHODS
We surveyed survivors in 7 primarily rural, Appalachian counties February to May 2020. Univariable analyses examined the distribution and prevalence of delayed/forgone care due to cost in the past year by independent variables. Chi-square or Fisher's tests examined bivariable differences. Logistic regressions assessed the odds of delayed/forgone care due to cost.
RESULTS
Respondents (n=428), aged 68.6 years on average (SD: 12.0), were 96.3% non-Hispanic white and 49.8% female; 25.0% reported delayed/forgone care due to cost. The response rate was 18.5%. The proportion of delayed/forgone care for those aged 18-64 years was 46.7% and 15.0% for those aged 65+ years (P<0.0001). Females aged 65+ years (OR: 2.00; CI: 1.02-3.93) had double the odds of delayed/forgone care due to cost compared to males aged 65+ years.
CONCLUSION
About one in four rural cancer survivors reported delayed/forgone care due to cost, with rates approaching 50% in survivors aged <65 years.
IMPACT
Clinical implications indicate the need to: 1) ask about the impact of care costs, and 2) provide supportive services to mitigate effects of treatment costs, particularly for younger and female survivors.
背景
关于农村癌症幸存者因费用问题而延迟或放弃医疗和心理健康护理的研究较少。
方法
2020年2月至5月，我们对7个主要位于阿巴拉契亚地区的农村县的幸存者进行了调查。单变量分析通过自变量研究了过去一年中因费用问题而延迟/放弃护理的分布和患病率。卡方检验或费舍尔检验用于检验双变量差异。逻辑回归评估了因费用问题而延迟/放弃护理的几率。
结果
受访者（n = 428）平均年龄为68.6岁（标准差：12.0），96.3%为非西班牙裔白人，49.8%为女性；25.0%的人报告因费用问题而延迟/放弃护理。回复率为18.5%。18 - 64岁人群中延迟/放弃护理的比例为46.7%，65岁及以上人群为15.0%（P < 0.0001）。65岁及以上的女性因费用问题而延迟/放弃护理的几率是65岁及以上男性的两倍（比值比：2.00；置信区间：1.02 - 3.93）。
结论
约四分之一的农村癌症幸存者报告因费用问题而延迟/放弃护理，65岁以下幸存者的这一比例接近50%。
影响
临床意义表明需要：1）询问护理费用的影响，2）提供支持性服务以减轻治疗费用的影响，特别是对于年轻和女性幸存者。
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