Health Insurance and Colorectal Cancer Survival in Khon Kaen, Thailand

Abstract

Background: Evidence from healthcare studies demonstrates that patients' health insurance affects service<br />accessibility and the outcome of treatment. However, assessment on how colorectal cancer survival relates to health<br />insurance is limited. Objective: The study examined the association between health insurance and colorectal cancer<br />survival in Khon Kaen, Thailand. Methods: The retrospective cohort study was conducted with 1,931 colorectal cancer<br />patients from Khon Kaen cancer registry between January 1, 2003 and December 31, 2012, and was followed-up until<br />December 31, 2015. Relative survival was used to estimate the survival rate. Cox proportional hazard regression was<br />used to estimate the relationship between health insurance and colorectal cancer survival, represented with the hazard<br />ratio. Result: Most of the participants were males, and the median age was 62 years. The median survival time was<br />2.25 years (95% CI: 2.00-2.51). The five-year observed survival rate and relative survival rate were 36.87 (95% CI:<br />34.66-39.08) and, 42.28 (95% CI: 39.75-44.81), respectively. The factors that showed significant associations with<br />poorer survival after adjustment for gender and age were non-surgical treatments (HRadj=1.88;95%CI=1.45-2.45),<br />advanced stage (III+IV) (HRadj=2.50; 95%CI=2.00-3.12), histological grading in poorly differentiated (HRadj=1.84;<br />95%CI=1.32-2.56), and Universal Coverage Scheme (HRadj=1.37;95%CI=1.09-1.72). Conclusion: The survival of<br />colorectal cancer patients in the Universal Coverage Scheme was likely to be poorer than in the Civil Servant Medical<br />Benefit Scheme. This indicates an urgent need for a national program for colorectal cancer screening in the general<br />population and access to health insurance.