Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2025; 17(4): 103629
Published online Apr 15, 2025. doi: 10.4251/wjgo.v17.i4.103629
Oesophageal cancer-specific mortality risk and public health insurance: Prospective cohort study from China
Xiang-Lin Wu, Xiao-Sheng Li, Jing-Han Cheng, Lin-Xin Deng, Zu-Hai Hu, Jun Qi, Hai-Ke Lei
Xiang-Lin Wu, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
Xiao-Sheng Li, Hai-Ke Lei, Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing 400030, China
Jing-Han Cheng, Lin-Xin Deng, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
Zu-Hai Hu, Department of Health Statistics, School of Public Health, Chongqing Medical University, Chongqing 400016, China
Jun Qi, Department of Thoracic Surgery, The People’s Hospital of Changshou Chongqing, Chongqing 401220, China
Co-first authors: Xiang-Lin Wu and Xiao-Sheng Li.
Co-corresponding authors: Jun Qi and Hai-Ke Lei.
Author contributions: Lei HK and Hu ZH contributed to conception and analysis the data; Wu XL and Li XS contributed to acquisition and drafting of the paper; Cheng JH and Deng LX contributed to interpretation of data and revising it critically for intellectual content; Qi J and Lei HK contributed to conception or design of the work and final approval of the version to be published; All authors agree to be accountable for all aspects of the work.
Supported by the Chongqing Science and Health Joint Medical Research Project, No. 2024MSXM065.
Institutional review board statement: The studies involving human participants were reviewed and approved by The Ethics Committee of Chongqing University Cancer Hospital (No. CZLS2023338-A).
Clinical trial registration statement: This study did not require clinical registration.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Ke Lei, PhD, Associate Professor, Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing 400030, China. tohaike@163.com
Received: November 26, 2024
Revised: January 9, 2025
Accepted: February 8, 2025
Published online: April 15, 2025
Processing time: 120 Days and 8.7 Hours
Abstract
BACKGROUND

Oesophageal cancer is a significant health concern worldwide, with high incidence and mortality rates. In China, the disease burden is particularly high, accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.

AIM

To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type, out-of-pocket ratio, and the joint effects of insurance type and out-of-pocket ratio.

METHODS

The χ2 test was used to analyze patients’ demographic and clinical characteristics. Multivariate logistic regression, the Cox proportional hazard model, and the competitive risk model were used to calculate the cumulative hazard ratios (HRs) of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.

RESULTS

Compared with patients covered by basic medical insurance for urban and rural residents, patients covered by urban employee basic medical insurance for urban workers (UEBMI) had a 23.30% increased risk of oesophageal cancer-specific death [HR = 1.233, 95% confidence interval (CI): 1.093-1.391, P < 0.005]. Compared with patients in the low out-of-pocket ratio group, patients in the high out-of-pocket ratio group had a 25.80% reduction in the risk of oesophageal cancer-specific death (HR = 0.742, 95%CI: 0.6555-0.84, P < 0.005). With each 10% increase in the out-of-pocket ratio, the risk of oesophageal cancer-specific death decreased by 10.10% in patients covered by UEBMI. However, the risk of oesophageal cancer-specific death increased by 26.90% in patients in the high out-of-pocket ratio group.

CONCLUSION

This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects. This study provides practical suggestions and guidance for the formulation of relevant policies in this area.

Keywords: Oesophageal cancer; Public health; Insurance; Prognosis; Mortality risk

Core Tip: The study reveals the intricate relationship between public health insurance, out-of-pocket payment ratios, and oesophageal cancer-specific mortality. It underscores the importance of insurance policy optimization to mitigate the mortality risk among high-risk groups and emphasizes the role of early intervention strategies in improving patient outcomes.