Sun Jung Kim, Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Seojin Park, Kyu-Tae Han
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引用次数: 0
Abstract
Background: The patterns of breast and cervical cancers have improved owing to national cancer control over the past decades, but the disparity in medical resources and increasing number of patients with cancer in the capital area have worsened. Previous studies have revealed the association of fragmented care (FC) with health disparities; however, studies have been lacking in women's cancers and outcomes. The study aims to examine the impact of FC in women with breast and cervical cancers and compare them according to health disparity factors.
Methods: Data used from the National Health Insurance (NHI) claim data from 2011 to 2021. Female patients with cancer aged ≥ 30 years were selected as the participants. The final population-based sample included 84,931 patients with breast cancer and 14,520 patients with cervical cancer. Regression and survival analyses were conducted to investigate the associations between length of stay (LOS), medical expenditure, 5-year mortality, and FC. Subgroup analyses were performed based on residential areas, type of hospital with major cancer treatment, and economic level to compare differences in the association with FC.
Results: Of the 84,931 patients with breast cancer and 14,520 with cervical cancer, 13,946 (16.4%) and 1,674 (11.5%) experienced FC, respectively. The LOS (Breast: RR 1.18, 95% CI 1.14-1.23; Cervical: RR 1.47, 95% CI 1.33-1.61) and medical expenditure (Breast: RR 1.08, 95% CI 1.07-1.10; Cervical: RR 1.49, 95% CI 1.39-1.59) were higher for patients with FC compared to those without. Higher risk of mortality was observed among patients with cervical cancer with FC (HR 1.48, 95% CI 1.33-1.65), but no significant association was observed in breast cancer (HR 0.95, 95% CI 0.87-1.03). These associations were greater in patients who lived in metropolitan areas, had a low economic status, or visited low-level hospitals.
Conclusion: FC can negatively affect the efficiency of healthcare delivery, resulting in excessive medical expenditures and deterioration of health outcomes. These associations may be greater under conditions of disparities in cancer care such as accessibility.
背景：过去几十年来，由于国家癌症控制，乳腺癌和宫颈癌的模式有所改善，但首都地区医疗资源的差距和癌症患者人数的增加加剧了。先前的研究揭示了碎片化护理（FC）与健康差异的关联；然而，对女性癌症及其结果的研究一直缺乏。该研究旨在检查FC对乳腺癌和宫颈癌女性的影响，并根据健康差异因素对其进行比较。方法：数据来自2011 - 2021年国民健康保险（NHI）索赔数据。选择年龄≥30岁的女性癌症患者作为研究对象。最终以人群为基础的样本包括84931名乳腺癌患者和14520名宫颈癌患者。通过回归分析和生存分析来研究住院时间（LOS）、医疗费用、5年死亡率和FC之间的关系。根据居民区、主要癌症治疗医院类型和经济水平进行亚组分析，比较与FC相关的差异。结果：在84931例乳腺癌患者和14520例宫颈癌患者中，分别有13946例（16.4%）和1674例（11.5%）发生FC。LOS (Breast): RR 1.18, 95% CI 1.14-1.23；宫颈癌：RR 1.47, 95% CI 1.33-1.61)和医疗支出(乳腺癌：RR 1.08, 95% CI 1.07-1.10；宫颈：RR 1.49, 95% CI 1.39-1.59)。宫颈癌合并FC患者的死亡风险较高（HR 1.48, 95% CI 1.33-1.65），但在乳腺癌患者中未观察到显著相关性（HR 0.95, 95% CI 0.87-1.03）。这些关联在居住在大都市地区、经济地位较低或去低级医院就诊的患者中更大。结论：FC会对医疗服务效率产生负面影响，导致医疗费用过高和健康结果恶化。在癌症治疗如可及性存在差异的情况下，这些关联可能会更大。
期刊介绍：
International Journal for Equity in Health is an Open Access, peer-reviewed, online journal presenting evidence relevant to the search for, and attainment of, equity in health across and within countries. International Journal for Equity in Health aims to improve the understanding of issues that influence the health of populations. This includes the discussion of political, policy-related, economic, social and health services-related influences, particularly with regard to systematic differences in distributions of one or more aspects of health in population groups defined demographically, geographically, or socially.
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