Effects of insurance status on long-term survival among non-small cell lung cancer (NSCLC) patients in Beijing, China: A population-based study

OBJECTIVE: To evaluate the effects of health insurance status on long-term cancer-specific survival of non-small cell lung cancer (NSCLC) in Beijing, China, using a population-based cancer registry data. METHODS: Information on NSCLC patients diagnosed in 2008 was derived from the Beijing Cancer Registry. The medical records of 1,134 cases were sampled and re-surveyed to obtain information on potential risk factors. Poorly-insured status was defined as Uninsured and New Rural Cooperative Medical Insurance Scheme (NRCMS), while well-insured included Urban Employees Basic Medical Insurance (UEBMI) and Free Medical Care (FMC). To estimate survival outcomes, individuals were followed-up until December 31, 2018. Cancer-specific survival probabilities at 5 and 10 years after diagnosis were estimated using the Kaplan-Meier method. Log-rank test was used to compare long-term survival with different characteristics. Multivariable Cox proportional hazard regression model was used to examine the relative effect of insurance status on cancer-specific mortality. RESULTS: Well-insured NSCLC patients have longer cancer-specific survival than poorly-insured individuals [hazard ratio (HR)=0.81; 95% confidence interval (95% CI): 0.67−0.97), even after adjusting for age, gender, cancer stage, smoking status, family history and residential area. Older age and rural residence were associated with a higher risk of cancer-specific mortality (HR=1.03; 95% CI: 1.02−1.03 and HR=1.25; 95% CI: 1.07−1.46, respectively). Smoking individuals had a 41% higher long-term cancer-specific mortality risk than non-smoking ones (HR=1.41; 95% CI: 1.20−1.66). CONCLUSIONS: NSCLC patients with good insurance status had better survival rates than those with poor insurance. An association was significant even after 10 years. Large population-based studies are needed to validate that high reimbursement insurance status can lead to the improvement of long-term cancer prognosis in China.