Public health insurance and the risk of cancer-specific mortality in patients with cervical cancer: A Chinese prospective cohort study

作者全名："Yuan, Li; Lei, Haike; Zou, Dongling; Wen, Baogang; Li, Xiuying; Xu, Qianjie; Wang, Ying; Zhou, Qi"

作者地址："[Yuan, Li; Zou, Dongling; Wen, Baogang; Li, Xiuying; Wang, Ying; Zhou, Qi] Chongqing Univ, Canc Hosp, Dept Gynecol Oncol, Chongqing, Peoples R China; [Lei, Haike] Chongqing Univ, Canc Hosp, Chongqing Canc Multi Big Data Applicat Engn Res Ct, Chongqing, Peoples R China; [Xu, Qianjie] Chongqing Med Univ, Sch Publ Hlth, Dept Hlth Stat, Chongqing, Peoples R China"

通信作者："Wang, Y; Zhou, Q (通讯作者)，Chongqing Univ, Canc Hosp, Dept Gynecol Oncol, Chongqing, Peoples R China."

来源：FRONTIERS IN PUBLIC HEALTH

ESI学科分类：SOCIAL SCIENCES, GENERAL

WOS号：WOS:000968187300001

JCR分区：Q2

影响因子：3

年份：2023

卷号：11

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：cervical cancer; cancer specific mortality; public health insurance; prognosis; prospective cohort study

摘要："ObjectiveCervical cancer has one of the highest incidence and mortality rates of any malignant tumor of the female reproductive tract, and its longer treatment period will place significant financial strain on patients and their families. Little is known about how health insurance policies influence cervical cancer prognosis, particularly in developing countries. The relationship between cervical cancer specific death and cervical cancer all-cause mortality with public health insurance, self-payment rate, and the combined effect of public health insurance and self-payment rate was investigated in this study. Materials and methodsFrom 2015 to 2019, a prospective longitudinal cohort study on cervical cancer was carried out in Chongqing, China. We chose 4,465 Chongqing University Cancer Hospital patients who had been diagnosed with cervical cancer between 2015 and 2019. The self-payment rate and public health insurance are taken into account in our subgroup analysis. After applying the inclusion and exclusion criteria, we describe the demographic and clinical traits of patients with various insurance plans and self-payment rates using the chi-square test model. The relationship between cervical cancer patients with various types of insurance, the self-payment rate, and treatment modalities is examined using the multivariate logistic regression model. After applying the inclusion and exclusion criteria, we summarize the demographic and clinical traits of patients with various insurance plans and self-payment rates using the chi-square test model. The association between cervical cancer patients with various types of insurance, the self-payment rate, and treatment modalities is examined using the multivariate logistic regression model. The cumulative hazard ratio of all-cause death and cervical cancer-specific mortality for various insurance types and self-payment rates was then calculated using the Cox proportional hazard model and the competitive risk model. ResultsThis study included a total of 3,982 cervical cancer patients. During the follow-up period (median 37.3 months, 95% CI: 36.40-38.20), 774 deaths were recorded, with cervical cancer accounting for 327 of them. Patients who obtained urban employee-based basic medical insurance (UEBMI) had a 37.1% lower risk of all-cause death compared to patients who received urban resident-based basic medical insurance (URBMI) (HRs = 0.629, 95% CI: 0.508-0.779, p = 0.001). Patients with a self-payment rate of more than 60% had a 26.9% lower risk of cervical cancer-specific mortality (HRs = 0.731, 95% CI: 0.561-0.952, p <0.02). ConclusionsThe National Medical Security Administration should attempt to include the more effective self-paid anti-tumor medications into national medical insurance coverage within the restrictions of restricted medical insurance budget. This has the potential to reduce not only the mortality rate of cervical cancer patients, but also their financial burden. High-risk groups, on the other hand, should promote cervical cancer screening awareness, participate actively in the state-led national cancer screening project and enhance public awareness of HPV vaccine. This has the potential to reduce both cervical cancer patient mortality and the financial burden and impact."

基金机构：Chongqing University Cancer Hospital

基金资助正文：The authors are grateful to Chongqing University Cancer Hospital and the assistance of Chongqing Medical University faculty.