Wu Xiang-Lin, Li Xiao-Sheng, Cheng Jing-Han, Deng Lin-Xin, Hu Zu-Hai, Qi Jun, Lei Hai-Ke
Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China.
Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing 400030, China.
World J Gastrointest Oncol. 2025 Apr 15;17(4):103629. doi: 10.4251/wjgo.v17.i4.103629.
Oesophageal cancer is a significant health concern worldwide, with high incidence and mortality rates. In China, the disease burden is particularly high, accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.
To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type, out-of-pocket ratio, and the joint effects of insurance type and out-of-pocket ratio.
The test was used to analyze patients' demographic and clinical characteristics. Multivariate logistic regression, the Cox proportional hazard model, and the competitive risk model were used to calculate the cumulative hazard ratios (HRs) of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.
Compared with patients covered by basic medical insurance for urban and rural residents, patients covered by urban employee basic medical insurance for urban workers (UEBMI) had a 23.30% increased risk of oesophageal cancer-specific death [HR = 1.233, 95% confidence interval (CI): 1.093-1.391, < 0.005]. Compared with patients in the low out-of-pocket ratio group, patients in the high out-of-pocket ratio group had a 25.80% reduction in the risk of oesophageal cancer-specific death (HR = 0.742, 95%CI: 0.6555-0.84, < 0.005). With each 10% increase in the out-of-pocket ratio, the risk of oesophageal cancer-specific death decreased by 10.10% in patients covered by UEBMI. However, the risk of oesophageal cancer-specific death increased by 26.90% in patients in the high out-of-pocket ratio group.
This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects. This study provides practical suggestions and guidance for the formulation of relevant policies in this area.
食管癌是全球重大的健康问题，发病率和死亡率都很高。在中国，疾病负担尤为严重，占全球食管癌病例及相关死亡的很大比例。
探讨食管癌患者死亡率与保险类型、自付比例以及保险类型和自付比例的联合效应之间的关系。
采用 检验分析患者的人口统计学和临床特征。使用多因素逻辑回归、Cox 比例风险模型和竞争风险模型计算不同保险类型和自付比例患者全因死亡和食管癌特异性死亡的累积风险比（HR）。
与城乡居民基本医疗保险覆盖的患者相比，城镇职工基本医疗保险（UEBMI）覆盖的患者食管癌特异性死亡风险增加 23.30%[HR = 1.233，95%置信区间（CI）：1.093 - 1.391，< 0.005]。与低自付比例组患者相比，高自付比例组患者食管癌特异性死亡风险降低 25.80%（HR = 0.742，95%CI：0.6555 - 0.84，< 0.005）。在 UEBMI 覆盖的患者中，自付比例每增加 10%，食管癌特异性死亡风险降低 10.10%。然而，高自付比例组患者的食管癌特异性死亡风险增加了 26.90%。
本研究揭示了食管癌患者的特异性死亡率与自付比例、医疗保险类型及其联合效应之间的关系。本研究为该领域相关政策的制定提供了实用建议和指导。
