Does low income effects 5-year mortality of hepatocellular carcinoma patients?

International Journal for Equity in Health

Sun Jung Kim¹  Seung Ju Kim²  Dong Jun Kim³  Jong Wha Chang⁴  Ji Won Yoo⁵  Eun-Cheol Park⁶  Takashi Yamashita⁷  Kyu-Tae Han⁸ 

[1] Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea;Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, 22 Soonchunhyang-ro, 31538, Asan, Republic of Korea;Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea;College of Nursing, Catholic University of Korea, Seoul, Republic of Korea;Department of Health Administration and Management, Soonchunhyang University Graduate School, Asan, Republic of Korea;Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea;Department of Health Administration, College of Business, Texas Womenʼs University, Denton, TX, USA;Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA;Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea;Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore, MD, USA;Division of Cancer Management Policy, National Cancer Center, Goyang, Republic of Korea;

关键词: Hepatocellular carcinoma;    Liver Cancer;    Low income;    Mortality;    Multi-level analysis;    Cox proportional hazard model;   

DOI  :  10.1186/s12939-021-01498-z

来源: Springer

【 摘 要 】

BackgroundIn Korea, the universal health system offers coverage to all members of society. Despite this, it is unclear whether risk of death from hepatocellular carcinoma (HCC) varies depending on income. We evaluated the impact of low income on HCC mortality.MethodsThe Korean National Health Insurance sampling cohort was used to identify new HCC cases (n = 7325) diagnosed between 2004 and 2008, and the Korean Community Health Survey data were used to investigate community-level effects. The main outcome was 5-year all-cause mortality risk, and Cox proportional hazard models were applied to investigate the individual- and community-level factors associated with the survival probability of HCC patients.ResultsFrom 2004 to 2008, there were 4658 new HCC cases among males and 2667 new cases among females. The 5-year survival proportion of males was 68%, and the incidence per person-year was 0.768; the female survival proportion was 78%, and the incidence per person-year was 0.819. Lower income was associated with higher hazard ratio (HR), and HCC patients with hepatitis B (HBV), alcoholic liver cirrhosis, and other types of liver cirrhosis had higher HRs than those without these conditions. Subgroup analyses showed that middle-aged men were most vulnerable to the effects of low income on 5-year mortality, and community-level characteristics were associated with survival of HCC patients.ConclusionHaving a low income significantly affected the overall 5-year mortality of Korean adults who were newly diagnosed with HCC from 2004 to 2008. Middle-aged men were the most vulnerable. We believe our findings will be useful to healthcare policymakers in Korea as well as to healthcare leaders in countries with NHI programs who need to make important decisions about allocation of limited healthcare resources according to a consensually accepted and rational framework.

【 授权许可】

CC BY