美国:医疗保险状况与癌症诊断和生存

2022
08/07

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对于所有分期癌症的合并和六个癌症部位——前列腺、结直肠、非霍奇金淋巴瘤、口腔、肝脏和食道,未保险的I期疾病患者的生存率低于私人保险的II期疾病患者。没有私人保险的患者在所有癌症的每个阶段的短期和长期生存率都较差;无保险的患者在17种分期癌症中有12种的分期生存率较差,白血病和脑瘤的生存率较差。扩大全面医疗保险覆盖范围对于改善癌症护理和结果,包括诊断阶段和生存期至关重要。

Abstract | 摘要

Previous studies using data from the early 2000s demonstrated that patients who were uninsured were more likely to present with late-stage disease and had worse short-term survival after cancer diagnosis in the United States. In this report, the authors provide comprehensive data on the associations of health insurance coverage type with stage at diagnosis and long-term survival in individuals aged 18-64 years who were diagnosed between 2010 and 2013 with 19 common cancers from the National Cancer Database, with survival follow-up through December 31, 2019. Compared with privately insured patients, Medicaid-insured and uninsured patients were significantly more likely to be diagnosed with late-stage (III/IV) cancer for all stageable cancers combined and separately. For all stageable cancers combined and for six cancer sites-prostate, colorectal, non-Hodgkin lymphoma, oral cavity, liver, and esophagus-uninsured patients with Stage I disease had worse survival than privately insured patients with Stage II disease. Patients without private insurance coverage had worse short-term and long-term survival at each stage for all cancers combined; patients who were uninsured had worse stage-specific survival for 12 of 17 stageable cancers and had worse survival for leukemia and brain tumors. Expanding access to comprehensive health insurance coverage is crucial for improving access to cancer care and outcomes, including stage at diagnosis and survival.

先前使用2000年代早期数据的研究表明,在美国,未投保的患者更有可能出现晚期疾病,并且在癌症诊断后短期生存率更差。在本报告中,作者提供了关于健康保险覆盖类型与诊断阶段和长期生存率之间关系的全面数据,这些年龄在18-64岁的患者在2010年至2013年间被诊断为国家癌症数据库中的19种常见癌症,并随访至2019年12月31日。与私人保险患者相比,在所有癌症分期中,Medicaid保险和未保险患者合并或单独诊断为晚期(III/IV)癌症的可能性显著增加。对于所有分期癌症的合并和六个癌症部位——前列腺、结直肠、非霍奇金淋巴瘤、口腔、肝脏和食道,未保险的I期疾病患者的生存率低于私人保险的II期疾病患者。没有私人保险的患者在所有癌症的每个阶段的短期和长期生存率都较差;无保险的患者在17种分期癌症中有12种的分期生存率较差,白血病和脑瘤的生存率较差。扩大全面医疗保险覆盖范围对于改善癌症护理和结果,包括诊断阶段和生存期至关重要。

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关键词:
医疗保险,私人保险,分期癌症,癌症

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