Abstract
Objective: Health disparities related to basic medical insurance in China have not been sufficiently examined, particularly among patients with hepatocellular carcinoma (HCC). This study aims to investigate the disparities in HCC survival by insurance status in Tianjin, China.Methods: This retrospective analysis used data from the Tianjin Basic Medical Insurance claims database, which consists of enrollees covered by Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Resident Basic Medical Insurance (URRBMI). Adult patients newly diagnosed with HCC between 2011 and 2016 were identified and followed until death from any cause, withdrawal from UEBMI or URRBMI, or the latest data in the dataset (censoring as of December 31st 2017), whichever occurred first. Patients' overall survival during the follow-up was assessed using Kaplan-Meier and extrapolated by six parametric models. The hazard ratio (HR) and 95% confidence intervals (CI) were calculated with the adjusted Cox proportional hazards model including age at diagnosis, sex, baseline comorbidities and complications, baseline healthcare resources utilization and medical costs, tumor metastasis at diagnosis, the initial treatment after diagnosis and antiviral therapy during the follow-up.Results: Two thousand sixty eight patients covered by UEBMI (N = 1,468) and URRBMI (N = 570) were included (mean age: 60.6 vs. 60.9, p = 0.667; female: 31.8 vs. 27.7%, p = 0.074). The median survival time for patients within the UEBMI and URRBMI were 37.8 and 12.2 months, and the 1-, 3-, 5-, 10-year overall survival rates were 63.8, 50.2, 51.0, 33.4, and 44.4, 22.8, 31.5, 13.1%, respectively. Compared with UEBMI, patients covered by URRBMI had 72% (HR: 1.72; 95% CI: 1.47–2.00) higher risk of death after adjustments for measured confounders above. The survival difference was still statistically significant (HR: 1.49; 95% CI: 1.21–1.83) in sensitivity analysis based on propensity score matching.Conclusions: This study reveals that HCC patients covered by URRBMI may have worse survival than patients covered by UEBMI. Further efforts are warranted to understand healthcare disparities for patients covered by different basic medical insurance in China.
Highlights
Primary liver cancer is the sixth commonly diagnosed cancer and the third leading cause of cancer death worldwide, with about 905,667 new cases and 830,180 deaths in 2020 [1]
Compared with patients covered by Urban Employee Basic Medical Insurance (UEBMI), those in the Urban and Rural Resident Basic Medical Insurance (URRBMI) cohort tended to use fewer healthcare resources with lower related medical costs during the baseline period and were with lower Charlson Comorbidity Index (CCI) scores, but were more likely to be diagnosed with severe liver diseases such as decompensated cirrhosis, liver failure and ascites (Table 1)
Supplementary Table S4). 1, 3, 5-year overall survival rates among patients covered by UEBMI were 63.8, 51.0, and 44.4%, compared with 50.2, 33.4, and 22.8% among patients covered by URRBMI (p < 0.001; Table 1, Figure 2)
Summary
Primary liver cancer is the sixth commonly diagnosed cancer and the third leading cause of cancer death worldwide, with about 905,667 new cases and 830,180 deaths in 2020 [1]. China is the most afflicted country with almost half of global newly diagnosed patients and fatalities (410,038 new cases and 391,152 deaths in 2020) [2]. Hepatocellular carcinoma (HCC) accounts for ∼90% of all local primary liver cancer, followed by intrahepatic cholangiocarcinoma amongst other types [4]. Effective HCC treatment options, depending on the tumor stage and the underlying liver function, include hepatectomy, liver transplantation, transarterial chemoembolization (TACE), ablation, radiotherapy, and systemic therapies. Previous studies have indicated that patients with cancer may alter treatment options to reduce the out-of-pocket expenses and ease their financial burden [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
