Prognostic influence of Korean public medical insurance system on breast cancer patients

Ki-Tae Hwang; Young Wook Ju; Young A Kim; Jongjin Kim; Sohee Oh; Jiwoong Jung; Young Jun Chai; In Sil Choi; So Won Oh

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저자정보: Ki-Tae Hwang (Seoul Metropolitan Government - Seoul National University Boramae Medical Center) Young Wook Ju (Seoul National University Hospital) Young A Kim (Seoul Metropolitan Government - Seoul National University Boramae Medical Center) Jongjin Kim (Seoul Metropolitan Government - Seoul National University Boramae Medical Center) Sohee Oh (Seoul Metropolitan Government - Seoul National University Boramae Medical Center) Jiwoong Jung (Seoul Medical Center) Young Jun Chai (Seoul Metropolitan Government - Seoul National University Boramae Medical Center) In Sil Choi (Seoul Metropolitan Government - Seoul National University Boramae Medical Center) So Won Oh (Seoul Metropolitan Government - Seoul National University Boramae Medical Center)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.96 No.2

발행연도: 2019.2

수록면: 58 - 69 (12page)

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Purpose: To investigate the prognostic influence of Korean public medical insurance system on breast cancer patients.
Methods: Data of 1,068 patients with primary invasive breast cancer were analyzed. Korean public medical insurance status was classified into 2 groups: National Health Insurance and Medical Aid. Kaplan-Meier estimator and Cox proportional hazards model were used for survival analysis.
Results: The Medical Aid group showed worse prognoses compared to the National Health Insurance group both in overall survival (P = 0.001) and recurrence-free survival (P = 0.006). The Medical Aid group showed higher proportion of patients with tumor size > 2 cm (P = 0.022), more advanced stage (P = 0.039), age > 50 years (P = 0.003), and low education level (P = 0.003). The Medical Aid group showed higher proportion of patients who received mastectomy (P < 0.001) and those who received no radiation therapy (P = 0.013). The Medical Aid group showed a higher rate of distant recurrence (P = 0.014) and worse prognosis for the triple negative subtype (P = 0.006). Medical insurance status was a significant independent prognostic factor in both univariate analysis and multivariate analysis.
Conclusion: The Medical Aid group had worse prognosis compared to the National Health Insurance group. Medical insurance status was a strong independent prognostic factor in breast cancer. Unfavorable clinicopathologic features could explain the worse prognosis for the Medical Aid group. Careful consideration should be given to medical insurance status as one of important prognostic factors for breast cancer patients.

#Breast neoplasms #Insurance #National Health Insurance #Prognosis

참고문헌 (28)

참고문헌 신청

Roetzheim RG / 1999 / Effects of health insurance and race on early detection of cancer / J Natl Cancer Inst 91:1409~1415

Halpern MT / 2008 / Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites : a retrospective analysis / Lancet Oncol 9:222~231

Ward EM / 2010 / The association of insurance and stage at diagnosis among patients aged 55 to 74 years in the national cancer database / Cancer J 16:614~621

Richardson LC / 2004 / Treatment of breast cancer in medically underserved women : a review / Breast J 10:2~5

Grau JJ / 2013 / Prognosis in women with breast cancer and private extra insurance coverage / Ann Surg Oncol 20:2822~2827

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Ki-Tae Hwang

소속기관 Seoul Metropolitan Government Seoul National University Boramae Medical Center

주요연구분야 의약학 > 임상의학 > 일반 외과학 의약학 > 기초의학 > 예방의학·직업환경의학

논문수 39 이용수 582

Young Wook Ju

소속기관 Seoul National University Hospital