Survival difference due to types of health coverage in breast cancer patients treated at a specialized cancer center in Medellín, Colombia

Abstract: The study aimed to estimate the effect of health insurance on overall survival and disease-free survival in breast cancer patients undergoing surgery at the Las Américas Oncology Institute in Medellín, Colombia, with data from the institutional registry. The variables were compared between subsidized coverage and contributive coverage with chi-squared test (χ2) or Student t test, Kaplan-Meier, and log-rank test. The target variable was adjusted with Cox regression. There were 2,732 patients with a median follow-up of 36 months. Ten percent of the women with contributive coverage died, compared to 23% of the subsidized coverage group. There were differences in time-to-treatment (contributive group with 52 days versus subsidized group with 112 days, p < 0.05). Disease-free survival and overall survival were better in women with contributive coverage compared to those with subsidized coverage (p < 0.05), and overall survival varied according to tumor and treatment variables. Overall survival and disease-free survival and early time-to-diagnosis and treatment were better in patients with contributive coverage compared to those with subsidized coverage.

摘要：本研究基于哥伦比亚麦德林市拉斯阿梅里卡斯肿瘤学研究所（Las Américas Oncology Institute）的机构登记数据，旨在评估健康保险对接受手术治疗的乳腺癌患者总生存期（overall survival）与无病生存期（disease-free survival）的影响。研究采用卡方检验（chi-squared test, χ²）、学生t检验（Student t test）、Kaplan-Meier法及对数秩检验（log-rank test）对补贴型医保与缴费型医保组的变量进行比较，并通过Cox回归（Cox regression）对目标变量进行校正。本研究共纳入2732例患者，中位随访时间为36个月。缴费型医保组女性死亡率为10%，补贴型医保组女性死亡率则为23%。两组治疗等待时间存在显著差异：缴费型组为52天，补贴型组为112天（p < 0.05）。缴费型医保女性的无病生存期与总生存期均优于补贴型医保组（p < 0.05），且总生存期随肿瘤及治疗相关变量的不同而存在差异。相较于补贴型医保患者，缴费型医保患者的总生存期、无病生存期以及更早的诊断与治疗时机均更具优势。