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Does low income effects 5-year mortality of hepatocellular carcinoma patients?

Authors
 Dong Jun Kim  ;  Ji Won Yoo  ;  Jong Wha Chang  ;  Takashi Yamashita  ;  Eun-Cheol Park  ;  Kyu-Tae Han  ;  Seung Ju Kim  ;  Sun Jung Kim 
Citation
 INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH, Vol.20(1) : 151, 2021-09 
Journal Title
INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH
Issue Date
2021-09
MeSH
Adult ; Aged ; Carcinoma, Hepatocellular* / mortality ; Female ; Health Status Disparities* ; Humans ; Income* / statistics & numerical data ; Liver Neoplasms* / mortality ; Male ; Middle Aged ; Mortality / trends ; Republic of Korea / epidemiology
Keywords
Cox proportional hazard model ; Hepatocellular carcinoma ; Liver Cancer ; Low income ; Mortality ; Multi-level analysis
Abstract
Background: In Korea, the universal health system offers coverage to all members of society. Despite this, it is unclear whether risk of death from hepatocellular carcinoma (HCC) varies depending on income. We evaluated the impact of low income on HCC mortality.

Methods: The Korean National Health Insurance sampling cohort was used to identify new HCC cases (n = 7325) diagnosed between 2004 and 2008, and the Korean Community Health Survey data were used to investigate community-level effects. The main outcome was 5-year all-cause mortality risk, and Cox proportional hazard models were applied to investigate the individual- and community-level factors associated with the survival probability of HCC patients.

Results: From 2004 to 2008, there were 4658 new HCC cases among males and 2667 new cases among females. The 5-year survival proportion of males was 68%, and the incidence per person-year was 0.768; the female survival proportion was 78%, and the incidence per person-year was 0.819. Lower income was associated with higher hazard ratio (HR), and HCC patients with hepatitis B (HBV), alcoholic liver cirrhosis, and other types of liver cirrhosis had higher HRs than those without these conditions. Subgroup analyses showed that middle-aged men were most vulnerable to the effects of low income on 5-year mortality, and community-level characteristics were associated with survival of HCC patients.

Conclusion: Having a low income significantly affected the overall 5-year mortality of Korean adults who were newly diagnosed with HCC from 2004 to 2008. Middle-aged men were the most vulnerable. We believe our findings will be useful to healthcare policymakers in Korea as well as to healthcare leaders in countries with NHI programs who need to make important decisions about allocation of limited healthcare resources according to a consensually accepted and rational framework.
Files in This Item:
T202104578.pdf Download
DOI
10.1186/s12939-021-01498-z
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/186766
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