Abstract
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.
Highlights
In Korea, the universal health system offers coverage to all members of society
We evaluated whether this association differed by age and sex and estimated the hepatocellular carcinoma (HCC)-related mortality risks associated with individual-level demographic characteristics
Patients with liver cirrhosis had higher mortality rates and shorter survival times than patients without cirrhosis, but an inverse association was found for patients with Hepatitis B (HBV) or Hepatitis C (HCV)
Summary
In Korea, the universal health system offers coverage to all members of society It is unclear whether risk of death from hepatocellular carcinoma (HCC) varies depending on income. In 2018, HCC was the second most common cause of cancer-related mortality in Korea, with a rate of 20.7 per 100,000 [2], which is two- to five-fold higher than in most European countries and the United States [1]. Low income, which is usually defined as the bottom 20% of the income distribution in a country [7], can increase the risk for mortality in HCC patients [5, 6]. There have been no nationwide studies on the effects of income on HCC mortality under the universal health system, a study of Ontario [9] residents showed that HCC patients in the lowest income quintile had a 10% higher HCC-related mortality rate than other groups [9]
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