Differences in the Survival of Gastric Cancer Patients after Gastrectomy according to the Medical Insurance Status

Abstract

PurposeIn Korea, the entire population must enroll in the national health insurance system, and those who are classified as having a lower socioeconomic status are supported by the medical aid system. The aim of this study was to evaluate the association of the medical insurance status of gastric cancer patients with their survival after gastrectomy.Materials and MethodsA total of 247 patients who underwent surgical treatment for gastric cancer between January 1999 and December 2010 at the Seoul Medical Center were evaluated. Based on their medical insurance status, the patients were classified into two groups: the national health insurance registered group (n=183), and the medical aid covered group (n=64). The survival rates were calculated using the Kaplan-Meier method.ResultsThe median postoperative duration of hospitalization was longer in the medical aid covered group and postoperative morbidity and mortality were higher in the medical aid group than in the national health insurance registered group (P<0.05). The overall 5-year survival rate was 43.9% in the medical aid covered group and 64.3% in the national health insurance registered group (P=0.001).ConclusionsThe medical insurance status reflects the socioeconomic status of a patient and can influence the overall survival of gastric cancer patients. A more sophisticated analysis of the difference in the survival time between gastric cancer patients based on their socioeconomic status is necessary.

Occupational Class and Cancer Survival in Korean Men: Follow-Up Study of Nation-Wide Working Population

“…Although extensive studies have documented socioeconomic disparities in cancer survival in Western settings, studies in the Asian context remain sparse [5,6]. In South Korea, previous studies have been published on socioeconomic inequalities in cancer survival, but these have been limited to single cancer sites [7,8] and/or unrepresentative samples [9,10]. In these previous studies, the indicators to assess socioeconomic status (SES) included educational level, income (health insurance premium as a surrogate for income), medical insurance status and area-level socioeconomic indices.…”

Asociación entre seguro de salud y mortalidad por adenocarcinoma gástrico en un centro especializado en Lima, Perú en el 2014 y 2015

“…El hallazgo es consistente con otros estudios de la región; por ejemplo, en Colombia, los pacientes con seguro contributorio tenían 80% mayor sobrevida frente a los subsidiados por el estado (27). La misma situación ocurre en Corea del Sur, en donde los pacientes con seguros no públicos tienen 90% mayor sobrevida frente a los públicos (18).…”

“…Por otro lado, no se encontró asociación entre mortalidad y estado civil o edad. Sin embargo, en un estudio colombiano, pacientes solteros presentaron mayor mortalidad (12,27); y de acuerdo a diversas series, pacientes mayores de 60 años suelen tener menor sobrevida (18,26,31). En nuestra realidad este hallazgo probablemente se explica porque la mayoría de pacientes acuden en estadíos avanzados, tanto si son jóvenes como adultos mayores.…”

“…En nuestra realidad este hallazgo probablemente se explica porque la mayoría de pacientes acuden en estadíos avanzados, tanto si son jóvenes como adultos mayores. Tampoco se encontró diferencia en mortalidad de acuerdo al sexo, lo que se diferencia de otros estudios, en los que ser varón se encontró asociado a menor sobrevida (16,18,31).…”

“…De hecho, en Estados Unidos diversos estudios demuestran que el tipo de seguro influye en la mortalidad por cáncer (13)(14)(15)(16). Por otro lado, en estudios realizados en Asia se encontró que pacientes con cáncer gástrico que contaban con seguro privado presentaron menor mortalidad que los que tenían seguro público (17,18). Resultados similares se obtuvieron en Australia en cáncer de próstata y en Centro América en cáncer colorrectal (19) y leucemia (20).…”