背景:脆弱人群的癌症预后可能较差。本研究旨在确定获得健康的个人和城市特征,包括教育,使用健康保险,人均国内生产总值(GDPpc),和城市方面,这可能会影响食管癌患者的预后。
方法:城市集中度数据,行政级别,GDPpc,患者个体特征,从2013年至2022年的国家和州公共数据库中收集了医疗保健服务。这项研究包括圣保罗州的城市,巴西。独立变量,如GDPpc,城市集中,市政级别,健康保险状况,教育水平,并根据总生存期(OS)的结果评估个体癌症和患者特征,接受手术治疗的可能性,和开始治疗的时间。
结果:共有42个城市的9280例食管癌患者(85%的鳞状细胞癌和15%的腺癌)被纳入研究。在单变量分析中,高等教育(危险比[HR]=0.6;P<.001),女性(HR=0.85;P<.001),和有私人健康保险(HR=0.65;P<.001)被确定为食管癌OS的保护因素。在多变量分析中调整其他变量后,高等教育(HR=0.77;P=0.009),女性(HR=0.82;P<.001),私人保险(HR=0.65;P<.001)仍然是保护因素。GDPpc与OS无关。城市集中度和等级制度影响了接受手术治疗的可能性。来自城市集中度较高的患者的治疗开始时间间隔较短。
结论:有风险的人群,特别是那些获得教育和医疗保健的机会有限的人,食管癌的预后较差。
BACKGROUND: Vulnerable populations potentially have a worse prognosis for cancer. The present
study aimed to identify individual and municipal characteristics of access to health, including education, use of health insurance, gross domestic product per capita (GDPpc), and urban aspects, which could impact the prognosis of patients with esophageal cancer.
METHODS: Data on urban concentration, administrative hierarchy, GDPpc, individual patient characteristics, and access to healthcare were collected from national and state public databases spanning between 2013 and 2022. The
study included cities in the state of Sao Paulo, Brazil. Independent variables such as GDPpc, urban concentration, municipal administrative hierarchy, health insurance status, education level, and individual cancer and patient characteristics were evaluated against the outcomes of overall survival (OS), likelihood of undergoing surgical treatment, and time-to-treatment initiation.
RESULTS: A total of 9280 patients with esophageal cancer (85% squamous cell carcinoma and 15% adenocarcinoma) treated in 42 cities were included in the
study. In univariate analysis, higher education (hazard ratio [HR] = 0.6; P < .001), female gender (HR = 0.85; P < .001), and having private health insurance (HR = 0.65; P < .001) were identified as protective factors for OS in esophageal cancer. After adjusting for other variables in multivariate analysis, higher education (HR = 0.77; P = .009), female gender (HR = 0.82; P < .001), and private insurance (HR = 0.65; P < .001) remained protective factors. GDPpc was not associated with OS. Urban concentration and hierarchy influenced the likelihood of receiving surgical treatment. Patients from high urban concentrations had shorter time-to-treatment initiation intervals.
CONCLUSIONS: Populations at risk, particularly those with limited access to education and healthcare, face a worse prognosis for esophageal cancer.