Public health insurance and cancer-specific mortality risk among patients with breast cancer: a prospective cohort study in China

Abstract

Abstract Background Little is known about how health insurance policies, particularly in developing countries, may influence breast cancer prognosis. We aimed to examine the association between individual health insurance plans and breast cancer-specific mortality among patients in China.Methods We included 7,436 women diagnosed with invasive breast cancer between January 1 st , 2009, and December 31 st , 2016, at West China Hospital, Sichuan University. The health insurance plan of each patient was classified as either urban or rural schemes and was also categorized as reimbursement rate (i.e., the covered/ total charge) below or above the median. Breast cancer-specific mortality was the primary outcome. Using Cox proportional hazards models, we calculated hazard ratios (HRs) for cancer-specific mortality, contrasting rates among patients with a rural insurance scheme or low reimbursement rate to that of those with an urban insurance scheme or high reimbursement rate, respectively.Results During the median follow-up of 3.1 years, we identified 326 deaths due to breast cancer. Compared with patients covered by urban insurance schemes, patients covered by rural insurance schemes had a 29% increased cancer-specific mortality (95% CI 0% to 65%, P=0.046) after adjusting for demographics, tumor characteristics, and treatment modes. Reimbursement rate below the median was associated with a 42% increased rate of cancer-specific mortality (95% CI 11% to 82%). Every 10% increase in the reimbursement rate is associated with a 7% (95% CI, 2% to 12%) reduction in cancer-specific mortality risk, particularly in patients covered by rural insurance schemes (26%, 95% CI 9% to 39%).Conclusions Our findings suggest that under-insured patients with breast cancer in China face increased breast cancer-specific mortality, which may provide fresh insights into the role of reimbursement rate in cancer health disparities.