Korean J Gastroenterol.  2018 Jul;72(1):15-20. 10.4166/kjg.2018.72.1.15.

Influence of Insurance Status on Survival of Surgically Treated Esophageal Cancer Patients

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea. moon730@medigate.net
  • 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

Abstract

BACKGROUND/AIMS
Socioecomomic factor is an important determinant of access to healthcare and is one of the potential causes of disparities in esophageal cancer care outcomes. The aim of the study was to clarify the association between National health Insurance status (health insurance vs. medicare) as a socioeconomic factor and survival of patients with esophageal cancer who underwent surgical resection.
METHODS
Among the 66 patients who underwent surgical resection for esophageal cancer between January 2006 and December 2017, 17 patients (25.8%) were in the medicare group. The data were analyzed to identify clinical manifestations and to compare surgical and oncologic outcomes between the groups.
RESULTS
There was no significant difference in the distribution of sex (p=0.13), age (p=0.24), and pathologic stage (p=0.61) between the groups. The length of median hospital stay was significantly shorter in the healthy insurance group (18 days vs. 25 days, p=0.04). In the medicare group, postoperative mortality rates and incidence of postoperative complication were non-significantly higher (11.8% vs. 6.1%, p=0.45, 64.7% vs. 46.7%, p=0.21, respectively). However, pulmonary complication rates, including pneumonia, acute respiratory distress syndorme, and prolonged air leakage was significantly higher in the medicare group (47.1% vs. 18.4%, p=0.02). Five-year disease free survival rate was not different between the two groups (61.0% vs. 54.5%, p=0.68); the 5-year overall survival rate was significantly lower in the medicare group (27.7% vs. 53.7%, p=0.03).
CONCLUSIONS
The medicare status of National health insurance could have a negative influence on the overall survival in patients with esophageal cancer who underwent surgery.

Keyword

Esophageal neoplasm; Surgery; Insurance coverage; Survival

MeSH Terms

Delivery of Health Care
Disease-Free Survival
Esophageal Neoplasms*
Fibrinogen
Humans
Incidence
Insurance Coverage*
Insurance*
Length of Stay
Medicare
Mortality
National Health Programs
Pneumonia
Postoperative Complications
Socioeconomic Factors
Survival Rate
Fibrinogen

Figure

  • Fig. 1. Five-year survival rate of patients between health insurance group (group H) and medicare group (group M). F/U, follow up.

  • Fig. 2. Five-year freedom from recurrence rate of patients between health insurance group (group H) and medicare group (group M). F/U, follow up.


Reference

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