IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0168684.html
   My bibliography  Save this article

Affluence and Private Health Insurance Influence Treatment and Survival in Non-Hodgkin’s Lymphoma

Author

Listed:
  • Harry Comber
  • Marianna De Camargo Cancela
  • Trutz Haase
  • Howard Johnson
  • Linda Sharp
  • Jonathan Pratschke

Abstract

Background: The aim of this study was to investigate inequalities in survival for non-Hodgkin’s lymphoma (NHL), distinguishing between direct and indirect effects of patient, social and process-of-care factors. Methods: All cases of NHL diagnosed in Ireland in 2004–2008 were included. Variables describing patient, cancer, stage and process of care were included in a discrete-time model of survival using Structural Equation Modelling software. Results: Emergency admissions were more common in patients with co-morbid conditions or with more aggressive cancers, and less frequent for patients from more affluent areas. Aggressive morphology, female sex, emergency admission, increasing age, comorbidity, treatment in a high caseload hospital and late stage were associated with increased hazard of mortality. Private patients had a reduced hazard of mortality, mediated by systemic therapy, admission to high caseload hospitals and fewer emergency admissions. Discussion: The higher rate of emergency presentation, and consequent poorer survival, of uninsured patients, suggests they face barriers to early presentation. Social, educational and cultural factors may also discourage disadvantaged patients from consulting with early symptoms of NHL. Non-insured patients, who present later and have more emergency admissions would benefit from better access to diagnostic services. Older patients remain disadvantaged by sub-optimal treatment, treatment in non-specialist centres and emergency admission.

Suggested Citation

  • Harry Comber & Marianna De Camargo Cancela & Trutz Haase & Howard Johnson & Linda Sharp & Jonathan Pratschke, 2016. "Affluence and Private Health Insurance Influence Treatment and Survival in Non-Hodgkin’s Lymphoma," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-14, December.
    • Handle: RePEc:plo:pone00:0168684
    DOI: 10.1371/journal.pone.0168684
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168684
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0168684&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0168684?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Mary Charlson & Martin T Wells & Ralph Ullman & Fionnuala King & Celia Shmukler, 2014. "The Charlson Comorbidity Index Can Be Used Prospectively to Identify Patients Who Will Incur High Future Costs," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-16, December.
    2. Chun-Ming Chang & Yu-Chieh Su & Ning-Sheng Lai & Kuang-Yung Huang & Sou-Hsin Chien & Yu-Han Chang & Wei-Cheng Lian & Ta-Wen Hsu & Ching-Chih Lee, 2012. "The Combined Effect of Individual and Neighborhood Socioeconomic Status on Cancer Survival Rates," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-10, August.
    3. Richéal M Burns & Linda Sharp & Francis J Sullivan & Sandra E Deady & Frances J Drummond & Ciaran O′Neill, 2014. "Factors Driving Inequality in Prostate Cancer Survival: A Population Based Study," PLOS ONE, Public Library of Science, vol. 9(9), pages 1-9, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. O’Brien, Gary L. & Sinnott, Sarah-Jo & O’ Flynn, Bridget & Walshe, Valerie & Mulcahy, Mark & Byrne, Stephen, 2020. "Out of pocket or out of control: A qualitative analysis of healthcare professional stakeholder involvement in pharmaceutical policy change in Ireland," Health Policy, Elsevier, vol. 124(4), pages 411-418.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Klein, Jens & von dem Knesebeck, Olaf, 2015. "Socioeconomic inequalities in prostate cancer survival: A review of the evidence and explanatory factors," Social Science & Medicine, Elsevier, vol. 142(C), pages 9-18.
    2. Mengna Luan & Wenjing Shi & Zhigang Tao & Hongjie Yuan, 2023. "When patients have better insurance coverage in China: Provider incentives, costs, and quality of care," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 31(4), pages 1073-1106, October.
    3. Chun-Ming Chang & Wen-Yao Yin & Chang-Kuo Wei & Chun-Hung Lin & Kuang-Yung Huang & Shih-Pin Lin & Cheng-Hung Lee & Pesus Chou & Ching-Chih Lee, 2013. "The Association of Socioeconomic Status and Access to Low-Volume Service Providers in Breast Cancer," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-1, December.
    4. Piotr Swierkowski & Adrian Barnett, 2018. "Identification of hospital cost drivers using sparse group lasso," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-19, October.
    5. Shih-Hsien Yang & Su-Feng Chen & Shin Nieh & Chia-Lin Liu & Yaoh-Shiang Lin & Ching-Chih Lee & Fu-Huang Lin, 2017. "The Effect of Individual and Neighbourhood Socioeconomic Status on Diabetes Mellitus Survival in Working Age Patients in Taiwan," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-11, January.
    6. Geir Fagerjord Lorem & Henrik Schirmer & Nina Emaus, 2016. "Health Impact Index. Development and Validation of a Method for Classifying Comorbid Disease Measured against Self-Reported Health," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-14, February.
    7. Tsu Jen Kuo & Pei Chen Wu & Pei Ling Tang & Chun-Hao Yin & Chi Hsiang Chu & Yao-Min Hung, 2019. "Effects of continuity of care on the postradiotherapy survival of working-age patients with oral cavity cancer: A nationwide population-based cohort study in Taiwan," PLOS ONE, Public Library of Science, vol. 14(12), pages 1-17, December.
    8. Ting-Shou Chang & Chun-Ming Chang & Ta-Wen Hsu & Yaoh-Shiang Lin & Ning-Sheng Lai & Yu-Chieh Su & Kuang-Yung Huang & Hung-Lung Lin & Ching-Chih Lee, 2013. "The Combined Effect of Individual and Neighborhood Socioeconomic Status on Nasopharyngeal Cancer Survival," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-9, September.
    9. Sheng-Wen Hou & Yi-Kung Lee & Chen-Yang Hsu & Ching-Chih Lee & Yung-Cheng Su, 2013. "Increased Risk of Acute Pancreatitis in Patients with Chronic Hemodialysis: A 4-Year Follow-Up Study," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-6, August.
    10. Chan‐Hoong Leong & Soo Jiuan Tan & Elizabeth A. Minton & Siok Kuan Tambyah, 2021. "Economic hardship and neighborhood diversity: Influences on consumer well‐being," Journal of Consumer Affairs, Wiley Blackwell, vol. 55(4), pages 1226-1248, December.
    11. Lena Harries & Jill Gwiasda & Zhi Qu & Harald Schrem & Christian Krauth & Volker Eric Amelung, 2019. "Potential savings in the treatment pathway of liver transplantation: an inter-sectorial analysis of cost-rising factors," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(2), pages 281-301, March.
    12. Woorim Kim & Seongkyeong Jang & Gangeun Lee & Yoon Jung Chang, 2021. "Disparities in Cancer-Related Avoidable Mortality by the Level of Area Deprivation in South Korea," IJERPH, MDPI, vol. 18(15), pages 1-8, July.
    13. Wei-Yin Kuo & Han-Sheng Hsu & Pei-Tseng Kung & Wen-Chen Tsai, 2021. "Impact of Socioeconomic Status on Cancer Incidence Risk, Cancer Staging, and Survival of Patients with Colorectal Cancer under Universal Health Insurance Coverage in Taiwan," IJERPH, MDPI, vol. 18(22), pages 1-17, November.
    14. Hla-Hla Thein & Kika Anyiwe & Nathaniel Jembere & Brian Yu & Prithwish De & Craig C Earle, 2017. "Effects of socioeconomic status on esophageal adenocarcinoma stage at diagnosis, receipt of treatment, and survival: A population-based cohort study," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-20, October.
    15. Chin-Chia Wu & Ta-Wen Hsu & Chun-Ming Chang & Chia-Hui Yu & Yuh-Feng Wang & Ching-Chih Lee, 2014. "The Effect of Individual and Neighborhood Socioeconomic Status on Gastric Cancer Survival," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-6, February.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0168684. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.