Open AccessAffluence and Private Health Insurance Influence Treatment and Survival in Non-Hodgkin’s Lymphoma
Author(s) -
Harry Comber,
Marianna de Camargo Cancela,
Trutz Haase,
Howard Johnson,
Linda Sharp,
Jonathan Pratschke
Publication year - 2016
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0168684
Subject(s) - medicine , disadvantaged , comorbidity , emergency department , proportional hazards model , hazard ratio , pediatrics , emergency medicine , psychiatry , confidence interval , political science , law
Background The aim of this study was to investigate inequalities in survival for non-Hodgkin’s lymphoma (NHL), distinguishing between direct and indirect effects of patient, social and process-of-care factors. Methods All cases of NHL diagnosed in Ireland in 2004–2008 were included. Variables describing patient, cancer, stage and process of care were included in a discrete-time model of survival using Structural Equation Modelling software. Results Emergency admissions were more common in patients with co-morbid conditions or with more aggressive cancers, and less frequent for patients from more affluent areas. Aggressive morphology, female sex, emergency admission, increasing age, comorbidity, treatment in a high caseload hospital and late stage were associated with increased hazard of mortality. Private patients had a reduced hazard of mortality, mediated by systemic therapy, admission to high caseload hospitals and fewer emergency admissions. Discussion The higher rate of emergency presentation, and consequent poorer survival, of uninsured patients, suggests they face barriers to early presentation. Social, educational and cultural factors may also discourage disadvantaged patients from consulting with early symptoms of NHL. Non-insured patients, who present later and have more emergency admissions would benefit from better access to diagnostic services. Older patients remain disadvantaged by sub-optimal treatment, treatment in non-specialist centres and emergency admission.