韩国不同收入水平癌症总体生存率差异分析

Disparities in Overall Survival Rates for Cancers across Income Levels in the Republic of Korea

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Cancers

影响因子:4.4

分区:医学3区 / 肿瘤学3区

发表日期:2024 Aug 22

作者: Su-Min Jeong, Kyu-Won Jung, Juwon Park, Hyeon Ji Lee, Dong Wook Shin, Mina Suh

DOI: 10.3390/cancers16162923

keywords: cancer survival; income disparity; slope index of inequality

摘要

癌症患者的总体生存率持续改善。然而，生存率的提升在社会经济地位之间并不均衡。因此，我们研究了韩国癌症患者5年生存率（5YSR）中的收入差异及其时间趋势。本研究采用2002年至2018年的国家癌症队列数据，通过连接韩国中央癌症登记处与国家健康保险服务（NHIS）理赔数据库，计算不同收入水平的癌症生存率。生存数据自2002年起可用，分析采用寿险法（actuarial method）。我们比较了2002-2006年和2014-2018年两个时间段的最早和最新的5年生存情况，观察截止至2021年12月31日。收入水平被划分为六类：医疗救助受益者和依据保险费的五个NHIS子类别。采用不平等斜率指数（SII）和相对不平等指数，分别衡量绝对和相对的5YSR差异。结果显示，所有癌症在2002-2006至2014-2018年期间的5YSR均有所改善。肺癌、肝癌和胃癌的5年生存率在研究期间表现出显著提升。肺癌（SII：17.5，95%置信区间（CI）：7.0-28.1）、肝癌（15.1，95% CI：10.9-19.2）、胃癌（13.9，95% CI：3.2-24.7）、结直肠癌（11.4，95% CI：0.9-22.0）以及前列腺癌（10.7，95% CI：2.5-18.8）的SII值显著较高，表明随着收入水平的提高，生存率也相应提高。研究期内，肺癌、肝癌和胃癌的SII有所增加，而甲状腺癌、乳腺癌、宫颈癌、前列腺癌和结直肠癌的SII有所下降。尽管从2002年至2018年，癌症类型和收入水平的5YSR均有显著提升，但这一增长并未在所有收入层次中均衡分布。本研究揭示了癌症患者生存中的持续收入差异，特别是在肺癌和肝癌方面。

Abstract

The overall survival rates among cancer patients have been improving. However, the increase in survival is not uniform across socioeconomic status. Thus, we investigated income disparities in the 5-year survival rate (5YSR) in cancer patients and the temporal trends.This study used a national cancer cohort from 2002 to 2018 that was established by linking the Korea Central Cancer Registry and the National Health Insurance Service (NHIS) claim database to calculate the cancer survival rate by income level in the Republic of Korea. Survival data were available from 2002 onward, and the analysis was based on the actuarial method. We compared the survival of the earliest available 5-year period of 2002-2006 and the latest available 5-year period of 2014-2018, observing until 31 December 2021. Income level was classified into six categories: Medical Aid beneficiaries and five NHIS subtypes according to insurance premium. The slope index of inequality (SII) and relative index of inequality were used to measure absolute and relative differences in 5YSR by income, respectively.The 5YSR between the 2002-2006 and 2014-2018 periods for all cancers improved. A significant improvement in 5-year survival rates (5YSR) over the study period was observed in lung, liver, and stomach cancer. The SII of survival rates for lung (17.5, 95% confidence interval (CI) 7.0-28.1), liver (15.1, 95% CI 10.9-19.2), stomach (13.9, 95% CI 3.2-24.7), colorectal (11.4, 95% CI 0.9-22.0), and prostate (10.7, 95% CI 2.5-18.8) cancer was significantly higher, implying higher survival rates as income levels increased. The SII for lung, liver, and stomach cancer increased, while that of thyroid, breast, cervical, prostate, and colorectal cancer decreased over the study period.Although substantial improvement in the 5YSR was observed across cancer types and income levels from 2002 to 2018, this increase was not uniformly distributed across income levels. Our study revealed persistent income disparities in the survival of cancer patients, particularly for lung and liver cancer.