Esteban Ramirez Ferrer, Juan Pablo Zuluaga-Garcia, Juan Diego Alzate, Juliana Mayorga-Corvacho, Maria Alejandra Sierra, Maria Osley Garzon-Duque, Alberto Daza-Ovalle, Humberto Madrinan-Navia, Mauricio Riveros-Castillo
{"title":"医疗保健差异对哥伦比亚高级别胶质瘤患者治疗和生存的影响:一项多中心逆概率加权队列分析","authors":"Esteban Ramirez Ferrer, Juan Pablo Zuluaga-Garcia, Juan Diego Alzate, Juliana Mayorga-Corvacho, Maria Alejandra Sierra, Maria Osley Garzon-Duque, Alberto Daza-Ovalle, Humberto Madrinan-Navia, Mauricio Riveros-Castillo","doi":"10.1007/s11060-025-05198-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Explore the impact of healthcare disparities in patients with high-grade glioma (HGG) in the Colombia's universal healthcare model setting, aiming to assess access to adjuvant treatment and survival outcomes among HGG patients covered under contributory versus subsidized insurance schemes in Bogotá, Colombia.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in two academic neurosurgical centers in Bogotá, Colombia, each serving patient populations with a differential distribution by insurance scheme. Adult patients with newly diagnosed high-grade glioma (HGG) who underwent surgical management between 2017 and 2021 were included. Patients with recurrent disease at presentation or lost to follow-up after surgery were excluded. Demographic, clinical, surgical, and treatment data were collected. The primary outcome was overall survival, assessed through medical records and the national death registry. A propensity score model with inverse probability of treatment weighting (IPTW) was used to adjust for confounding. Cox proportional hazards and logistic regression models were applied.</p><p><strong>Results: </strong>A total of 113 patients were included; 88 had contributory coverage and 25 had subsidized coverage. Patients in the subsidized group had significantly lower rates of postoperative medical oncology consultation (48% vs. 84%, 95% p < 0.001), chemotherapy (28% vs. 68.2%, p < 0.001), and radiotherapy (8% vs. 56.3%, p < 0.001). Median overall survival was significantly lower in the subsidized group (9.8 vs. 16.5 months, p = 0.006). After IPTW adjustment, subsidized insurance (HR 1.66, 95% CI 1.03-2.68, p = 0.035), subtotal resection (HR 1.58, 95% CI 1.01-2.49, p = 0.045), and lack of oncology consultation (HR 5.24, 95% CI 1.21-22.63, p = 0.026) were independently predicted worse survival. Female sex (OR 2.59, p = 0.045) and subsidized coverage (OR 8.21, p < 0.001) were associated with failure to complete oncology follow-up.</p><p><strong>Conclusions: </strong>In the context of a universal healthcare system such as Colombia's, differences in access to adjuvant therapy may contribute to survival disparities among patients with high-grade gliomas. While formal insurance coverage is broadly available, it does not necessarily ensure timely or equitable care delivery. Additionally, our findings suggest that gender-related factors may influence access to postoperative oncology care. Efforts to strengthen care coordination, address structural barriers, and ensure equitable access across insurance types and sexes could help improve outcomes in this population.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1067-1077"},"PeriodicalIF":3.1000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of healthcare disparities on the treatment and survival of patients with high-grade gliomas in Colombia: a multicenter inverse probability-weighted cohort analysis.\",\"authors\":\"Esteban Ramirez Ferrer, Juan Pablo Zuluaga-Garcia, Juan Diego Alzate, Juliana Mayorga-Corvacho, Maria Alejandra Sierra, Maria Osley Garzon-Duque, Alberto Daza-Ovalle, Humberto Madrinan-Navia, Mauricio Riveros-Castillo\",\"doi\":\"10.1007/s11060-025-05198-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Explore the impact of healthcare disparities in patients with high-grade glioma (HGG) in the Colombia's universal healthcare model setting, aiming to assess access to adjuvant treatment and survival outcomes among HGG patients covered under contributory versus subsidized insurance schemes in Bogotá, Colombia.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in two academic neurosurgical centers in Bogotá, Colombia, each serving patient populations with a differential distribution by insurance scheme. Adult patients with newly diagnosed high-grade glioma (HGG) who underwent surgical management between 2017 and 2021 were included. Patients with recurrent disease at presentation or lost to follow-up after surgery were excluded. Demographic, clinical, surgical, and treatment data were collected. The primary outcome was overall survival, assessed through medical records and the national death registry. A propensity score model with inverse probability of treatment weighting (IPTW) was used to adjust for confounding. Cox proportional hazards and logistic regression models were applied.</p><p><strong>Results: </strong>A total of 113 patients were included; 88 had contributory coverage and 25 had subsidized coverage. Patients in the subsidized group had significantly lower rates of postoperative medical oncology consultation (48% vs. 84%, 95% p < 0.001), chemotherapy (28% vs. 68.2%, p < 0.001), and radiotherapy (8% vs. 56.3%, p < 0.001). Median overall survival was significantly lower in the subsidized group (9.8 vs. 16.5 months, p = 0.006). After IPTW adjustment, subsidized insurance (HR 1.66, 95% CI 1.03-2.68, p = 0.035), subtotal resection (HR 1.58, 95% CI 1.01-2.49, p = 0.045), and lack of oncology consultation (HR 5.24, 95% CI 1.21-22.63, p = 0.026) were independently predicted worse survival. Female sex (OR 2.59, p = 0.045) and subsidized coverage (OR 8.21, p < 0.001) were associated with failure to complete oncology follow-up.</p><p><strong>Conclusions: </strong>In the context of a universal healthcare system such as Colombia's, differences in access to adjuvant therapy may contribute to survival disparities among patients with high-grade gliomas. While formal insurance coverage is broadly available, it does not necessarily ensure timely or equitable care delivery. Additionally, our findings suggest that gender-related factors may influence access to postoperative oncology care. Efforts to strengthen care coordination, address structural barriers, and ensure equitable access across insurance types and sexes could help improve outcomes in this population.</p>\",\"PeriodicalId\":16425,\"journal\":{\"name\":\"Journal of Neuro-Oncology\",\"volume\":\" \",\"pages\":\"1067-1077\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2025-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neuro-Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11060-025-05198-4\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/12 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuro-Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11060-025-05198-4","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/12 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:探讨哥伦比亚全民医疗保健模式下高级别胶质瘤(HGG)患者医疗保健差异的影响,旨在评估哥伦比亚波哥大自费与补贴保险计划覆盖的HGG患者获得辅助治疗和生存结果。方法:回顾性队列研究在哥伦比亚波哥大的两家学术神经外科中心进行,每个中心服务的患者群体根据保险计划的差异分布。纳入了2017年至2021年间接受手术治疗的新诊断的高级别胶质瘤(HGG)成年患者。排除就诊时疾病复发或术后随访失败的患者。收集了人口统计学、临床、外科和治疗数据。主要终点是通过医疗记录和国家死亡登记评估的总生存率。采用处理加权逆概率(IPTW)倾向评分模型对混杂因素进行校正。采用Cox比例风险模型和logistic回归模型。结果:共纳入113例患者;88个有缴费保险,25个有补贴保险。补贴组患者术后肿瘤内科会诊率明显较低(48% vs. 84%, 95% p)。结论:在哥伦比亚这样的全民医疗体系背景下,获得辅助治疗的差异可能导致高级别胶质瘤患者的生存差异。虽然正式保险覆盖范围广泛,但并不一定能确保及时或公平的医疗服务。此外,我们的研究结果表明,性别相关因素可能影响肿瘤术后护理的获得。努力加强护理协调,解决结构性障碍,确保不同保险类型和性别之间的公平获取,有助于改善这一人群的治疗结果。
Impact of healthcare disparities on the treatment and survival of patients with high-grade gliomas in Colombia: a multicenter inverse probability-weighted cohort analysis.
Purpose: Explore the impact of healthcare disparities in patients with high-grade glioma (HGG) in the Colombia's universal healthcare model setting, aiming to assess access to adjuvant treatment and survival outcomes among HGG patients covered under contributory versus subsidized insurance schemes in Bogotá, Colombia.
Methods: A retrospective cohort study was conducted in two academic neurosurgical centers in Bogotá, Colombia, each serving patient populations with a differential distribution by insurance scheme. Adult patients with newly diagnosed high-grade glioma (HGG) who underwent surgical management between 2017 and 2021 were included. Patients with recurrent disease at presentation or lost to follow-up after surgery were excluded. Demographic, clinical, surgical, and treatment data were collected. The primary outcome was overall survival, assessed through medical records and the national death registry. A propensity score model with inverse probability of treatment weighting (IPTW) was used to adjust for confounding. Cox proportional hazards and logistic regression models were applied.
Results: A total of 113 patients were included; 88 had contributory coverage and 25 had subsidized coverage. Patients in the subsidized group had significantly lower rates of postoperative medical oncology consultation (48% vs. 84%, 95% p < 0.001), chemotherapy (28% vs. 68.2%, p < 0.001), and radiotherapy (8% vs. 56.3%, p < 0.001). Median overall survival was significantly lower in the subsidized group (9.8 vs. 16.5 months, p = 0.006). After IPTW adjustment, subsidized insurance (HR 1.66, 95% CI 1.03-2.68, p = 0.035), subtotal resection (HR 1.58, 95% CI 1.01-2.49, p = 0.045), and lack of oncology consultation (HR 5.24, 95% CI 1.21-22.63, p = 0.026) were independently predicted worse survival. Female sex (OR 2.59, p = 0.045) and subsidized coverage (OR 8.21, p < 0.001) were associated with failure to complete oncology follow-up.
Conclusions: In the context of a universal healthcare system such as Colombia's, differences in access to adjuvant therapy may contribute to survival disparities among patients with high-grade gliomas. While formal insurance coverage is broadly available, it does not necessarily ensure timely or equitable care delivery. Additionally, our findings suggest that gender-related factors may influence access to postoperative oncology care. Efforts to strengthen care coordination, address structural barriers, and ensure equitable access across insurance types and sexes could help improve outcomes in this population.
期刊介绍:
The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.