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Prognostic influence of Korean public medical insurance system on breast cancer patients

Annals of Surgical Treatment and Research 2019년 96권 2호 p.58 ~ 69
 ( Hwang Ki-Tae ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Surgery

 ( Ju Young-Wook ) - Seoul National University Hospital Department of Surgery
 ( Kim Young-A ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Pathology
 ( Kim Jong-Jin ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Surgery
 ( Oh So-Hee ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Biostatistics
 ( Jung Ji-Woong ) - Seoul Medical Center Department of Surgery
 ( Chai Young-Jun ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Surgery
 ( Choi In-Sil ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Internal Medicine
 ( Oh So-Won ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Nuclear Medicine

Abstract

Purpose: To investigate the prognostic influence of Korean public medical insurance system on breast cancer patients.

Methods: Data of 1,068 patients with primary invasive breast cancer were analyzed. Korean public medical insurance status was classified into 2 groups: National Health Insurance and Medical Aid. Kaplan-Meier estimator and Cox proportional hazards model were used for survival analysis.

Results: The Medical Aid group showed worse prognoses compared to the National Health Insurance group both in overall survival (P = 0.001) and recurrence-free survival (P = 0.006). The Medical Aid group showed higher proportion of patients with tumor size > 2 cm (P = 0.022), more advanced stage (P = 0.039), age > 50 years (P = 0.003), and low education level (P = 0.003). The Medical Aid group showed higher proportion of patients who received mastectomy (P < 0.001) and those who received no radiation therapy (P = 0.013). The Medical Aid group showed a higher rate of distant recurrence (P = 0.014) and worse prognosis for the triple negative subtype (P = 0.006). Medical insurance status was a significant independent prognostic factor in both univariate analysis and multivariate analysis.

Conclusion: The Medical Aid group had worse prognosis compared to the National Health Insurance group. Medical insurance status was a strong independent prognostic factor in breast cancer. Unfavorable clinicopathologic features could explain the worse prognosis for the Medical Aid group. Careful consideration should be given to medical insurance status as one of important prognostic factors for breast cancer patients.

키워드

Breast neoplasms; Insurance; National Health Insurance; Prognosis
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