论文标题
智利乳腺癌结果的不平等：对病例死亡和生存率的分析（2007- 2018年）
Inequities in Breast Cancer Outcomes in Chile: An Analysis of Case Fatality and Survival Rates (2007-2018)
论文作者
论文摘要
简介：本文的目的是研究智利妇女的乳腺癌（BC）医疗保健结果，包括病例死亡（FR）和生存率（SR），按医疗保健提供者类型和地理区域进行分层。次要目标是估计医疗保健提供者和地区的BC发病率（IR）和死亡率（MR）率。方法：我们使用了卫生部提供的两个公共匿名数据库：国家死亡与医院释放数据集。为了生存分析，我们使用了95％CI和COX比例风险模型（CM）的Kaplan Meier产品限量估计量（KM），其无效 - 甲型化显着性测试的p> 0.001。结果：我们考虑了2007 - 2018年期间的58,254和16,615医院的出院和死亡人群。卑诗省造成的新病例和死亡分别增加了43.6％和33.6％。 AVG年龄调整后的IR和MR分别为44.0和10.5。隶属于私人提供商（ISAPRE）的妇女的AVG年龄为60.6，而隶属于公共提供商（FONASA）的妇女为38.8。随着时间的流逝，国家FR一直保持不变，平均为26.8。在研究期间，与ISAPRE相关的妇女的FR较低，而Fonasa女性为15.5。 Fonasa和Isapre的AVG 5年SR为0.81，0.90。来自大都市地区的妇女的SR比其他地区的妇女高。使用CM获得的SRS的行为与KM获得的行为相似。讨论：尽管2005年在GES计划中纳入了BC，但与Fonasa相比，隶属于ISAPRE的患者的FR和SR仍存在显着差异，而Fonasa的患者与社会经济水平直接相关，并且对于大都市和其他地区的患者而言。需要进一步的研究来确定这些差异的原因。
Introduction: The goal of this paper is to study inequities in breast cancer (BC) health care outcomes for Chilean women, including case fatality (FR) and survival rates (SR), stratified by type of health care provider and geographical area. A secondary goal is to estimate BC incidence (IR) and mortality (MR) rates by health care providers and region. Methods: We used two public anonymized databases provided by the Ministry of Health: the national death and hospital discharges datasets. For survival analysis, we used the Kaplan Meier product-limit estimator (KM) with a 95% ci and the Cox proportional hazards model (CM) with null-hypothesis significance testing of p>0.001. Results: We considered a cohort of 58,254 and 16,615 BC hospital discharges and deaths for the period 2007-2018. New cases and deaths due to BC increased by 43.6% and 33.6% respectively. Avg age-adjusted IR and MR were 44.0 and 10.5, respectively. Women affiliated to a private provider (ISAPRE) have an avg age adjusted IR of 60.6 compared to 38.8 for women affiliated with the public provider (FONASA). The national FR has remained constant over time, with a mean of 26.8. Women affiliated with ISAPRE had a considerably lower FR during the period under study, with an avg of 15.7 compared to 27.5 for women in FONASA. The avg 5-year SR were 0.81 and 0.90 for FONASA and ISAPRE. Women from the Metropolitan area have higher SRs than women from other regions. SRs obtained using the CM have a similar behavior to those obtained by the KM. Discussion: Despite the inclusion of BC in the GES plan in 2005 to provide greater, there are still significant differences in FR and SR for patients affiliated to ISAPRE compared to those in FONASA, a choice that is directly associated with socioeconomic level, and for patients in the Metropolitan and other regions. Further studies are required to determine the causes of these disparities.
