The impact of health insurance affiliation and socioeconomic status on cervical cancer survival in Bucaramanga,Colombia |
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| Institution: | 1. Department of Internal Medicine, Jackson Memorial Hospital / University of Miami Health System, FL, USA;2. The Population Registry of Cancer of the Metropolitan Area of Bucaramanga, Universidad Autónoma de Bucaramanga, Colombia;3. Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia;4. University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, FL, USA;1. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA;2. Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA;3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA;1. Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China;2. School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Street, Shenzhen 518055, China;1. Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA;2. Center for Integrative Oncology & Survivorship, Prisma Health, 900 W Faris Rd 1st Floor, Greenville, SC 29605, USA;3. Clemson Center for Geospatial Technologies, Clemson University Libraries, 116 Sigma Drive, Clemson, SC 29634, USA;1. Faculty of Pharmacy, Universidade Federal de Minas Gerais, Brazil;2. Ezequiel Dias Foundation, Brazil;3. Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil;1. Department of Radiotherapy, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil;2. Department of Education and Research, Hospital de Câncer de Pernambuco, Recife, Pernambuco, Brazil;3. Department of Head and Neck Surgery, Hospital de Câncer de Pernambuco, Recife, Pernambuco, Brazil;4. Department of Oncology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil;5. Department of Pneumology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil;6. Clinical Research Division, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil;1. Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA;2. Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA |
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| Abstract: | Cervical cancer is still an important cause of death in countries like Colombia. We aimed to determine whether socioeconomic status of residential address (SES) and type of health insurance affiliation (HIA) might be associated with cervical cancer survival among women in Bucaramanga, Colombia. All patients residing in the Bucaramanga Metropolitan Area diagnosed with invasive cervical cancer (ICD-0–3 codes C53.X) between 2008 and 2016 (n = 725) were identified through the population-based cancer registry, with 700 women having follow-up data for >5 years (date of study closure: Dec 31, 2021), yielding an overall 5-year survival estimate (95 % CI) of 56.4 % (52.7 – 60.0 %). KM estimates of 5-year overall survival were obtained to assess differences in cervical cancer survival by SES and HIA. Multivariable Cox-proportional hazards modeling was also conducted, including interaction effects between SES and HIA. Five-year overall survival was lower when comparing low vs. high SES (41.9 % vs 57.9 %, p < 0.0001) and subsidized vs. contributive HIA (45.1 % vs 63.0 %, p < 0.0001). Multivariable Cox modeling showed increased hazard ratios (HR) of death for low vs. high SES (HR = 1.78; 95 % CI = 1.18–2.70) and subsidized vs. contributive HIA (HR = 1.44; 95 % CI = 1.13–1.83). The greatest disparity in HR was among women of low SES affiliated to subsidized HIA (vs. contributive HIA and high SES) (HR=2.53; 95 % CI = 1.62–3.97). Despite Colombia’s universal healthcare system, important disparities in cervical cancer survival by health insurance affiliation and socioeconomic status remain. |
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| Keywords: | Cervical cancer Survival analysis Epidemiology Global health Socioeconomic disparities |
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