Sang Min Park1, Ki Young Son, Jae-Hyun Park, Belong Cho. 1. Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yeougeon-Dong, Jongno-Gu, Seoul, 110-774, South Korea.
Abstract
PURPOSE: This study was conducted in order to determine whether a gap exists between cancer patients with disabilities and those without disabilities with regard to short-term and long-term all-cause mortality in Korea. METHOD: The National Health Insurance claims database and the National Disability Database were used for performance of analyses. We identified 93,758 cancer patients (age, >20 years) who were diagnosed as cancer according to ICD-10 and who underwent treatment between January 1, 2000 and December 31, 2000. To distinguish between short-term and long-term survivorship outcomes, we performed survival analysis of short-term (<5 years) all-cause mortality for cancer patients and then confined our analysis to 5-year cancer survivors in order to assess the impacts of disability on long-term all-cause mortality. All analyses were performed according to gender, type of cancer, and type of disability, respectively, when cell sizes were large enough. RESULTS: Compared with the nondisability group, neither male nor female cancer patients with disabilities showed higher short-term (<5 years) all-cause mortality. When we confined our analysis to 5-year cancer survivors, both male (hazards ratio (HR), 1.48; 95% confidence interval (CI), 1.33-1.66) and female (HR, 1.53; 95% CI, 1.28-1.83) patients with prediagnosis disability had higher long-term all-cause mortality than those in the nondisability group. Male patients with impaired communication (HR, 1.24; 95% CI, 1.07-1.44) and female patients with internal disability (HR, 2.20; 95% CI, 1.42-3.42) had higher short-term (<5 years) all-cause mortality than those without these disabilities. Among both male (HR, 1.56; 95% CI, 1.38-1.75) and female (HR, 1.54; 95% CI, 1.28-1.86) 5-year cancer survivors, impaired mobility showed a significant association with a higher long-term mortality. CONCLUSIONS: This study raises concerns with regard to disability-related disparities in cancer outcome among long-term cancer survivors. Further attention and effective collaborative efforts are required for improvement of survival and quality of care for long-term cancer survivors.
PURPOSE: This study was conducted in order to determine whether a gap exists between cancerpatients with disabilities and those without disabilities with regard to short-term and long-term all-cause mortality in Korea. METHOD: The National Health Insurance claims database and the National Disability Database were used for performance of analyses. We identified 93,758 cancerpatients (age, >20 years) who were diagnosed as cancer according to ICD-10 and who underwent treatment between January 1, 2000 and December 31, 2000. To distinguish between short-term and long-term survivorship outcomes, we performed survival analysis of short-term (<5 years) all-cause mortality for cancerpatients and then confined our analysis to 5-year cancer survivors in order to assess the impacts of disability on long-term all-cause mortality. All analyses were performed according to gender, type of cancer, and type of disability, respectively, when cell sizes were large enough. RESULTS: Compared with the nondisability group, neither male nor female cancerpatients with disabilities showed higher short-term (<5 years) all-cause mortality. When we confined our analysis to 5-year cancer survivors, both male (hazards ratio (HR), 1.48; 95% confidence interval (CI), 1.33-1.66) and female (HR, 1.53; 95% CI, 1.28-1.83) patients with prediagnosis disability had higher long-term all-cause mortality than those in the nondisability group. Male patients with impaired communication (HR, 1.24; 95% CI, 1.07-1.44) and female patients with internal disability (HR, 2.20; 95% CI, 1.42-3.42) had higher short-term (<5 years) all-cause mortality than those without these disabilities. Among both male (HR, 1.56; 95% CI, 1.38-1.75) and female (HR, 1.54; 95% CI, 1.28-1.86) 5-year cancer survivors, impaired mobility showed a significant association with a higher long-term mortality. CONCLUSIONS: This study raises concerns with regard to disability-related disparities in cancer outcome among long-term cancer survivors. Further attention and effective collaborative efforts are required for improvement of survival and quality of care for long-term cancer survivors.
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