Do Patients Residing in Provincial Areas Transport and Spend More on Cancer Treatment in Korea?
Abstract
:1. Introduction
2. Methods
2.1. Data and Study Population
2.2. Outcome Measure
2.3. Interesting Variable
2.4. Covariates
2.5. Research Ethical Approval
2.6. Statistical Analysis
3. Results
4. Discussions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Total | Area of Residence vs. Location of Hospital Visited for Treatment | ||||
---|---|---|---|---|---|---|
Different | Identical | p-Value | ||||
N | % | N | % | |||
Residing area | ||||||
Capital area | 23,633 | 6208 | 26.3 | 17,425 | 73.7 | <0.0001 |
Metropolitan cities | 14,064 | 3366 | 23.9 | 10,698 | 76.1 | |
Provincial areas | 26,808 | 10,401 | 38.8 | 16,407 | 61.2 | |
Institution of main treatment | ||||||
General hospital | 44,108 | 16,507 | 37.4 | 27,601 | 62.6 | <0.0001 |
Hospital | 4641 | 1067 | 23.0 | 3574 | 77.0 | |
Long-term care hospital | 2959 | 761 | 25.7 | 2198 | 74.3 | |
Clinic | 12,797 | 1640 | 12.8 | 11,157 | 87.2 | |
Sex | ||||||
Male | 36,991 | 11,781 | 31.8 | 25,210 | 68.2 | <0.0001 |
Female | 27,514 | 8194 | 29.8 | 19,320 | 70.2 | |
Age | ||||||
~69 | 7084 | 2694 | 38.0 | 4390 | 62.0 | <0.0001 |
70~74 | 22,666 | 7643 | 33.7 | 15,023 | 66.3 | |
75~79 | 19,589 | 5727 | 29.2 | 13,862 | 70.8 | |
80~ | 15,166 | 3911 | 25.8 | 11,255 | 74.2 | |
Types of insurance coverage | ||||||
NHI self-employed | 6333 | 1275 | 20.1 | 5058 | 79.9 | <0.0001 |
NHI employed | 18,084 | 5441 | 30.1 | 12,643 | 69.9 | |
Medical Aid | 40,088 | 13,259 | 33.1 | 26,829 | 66.9 | |
Economic status | ||||||
Low | 17,316 | 4444 | 25.7 | 12,872 | 74.3 | <0.0001 |
Mid-low | 11,525 | 3531 | 30.6 | 7994 | 69.4 | |
Mid | 10,920 | 3499 | 32.0 | 7421 | 68.0 | |
Mid-high | 10,619 | 3692 | 34.8 | 6927 | 65.2 | |
High | 14,125 | 4809 | 34.0 | 9316 | 66.0 | |
Time since first diagnosis | ||||||
~1 y | 25,297 | 8976 | 35.5 | 16,321 | 64.5 | <0.0001 |
1~2 y | 13,583 | 4264 | 31.4 | 9319 | 68.6 | |
2~3 y | 10,545 | 3024 | 28.7 | 7521 | 71.3 | |
3~4 y | 8422 | 2133 | 25.3 | 6289 | 74.7 | |
4~5 y | 6658 | 1578 | 23.7 | 5080 | 76.3 | |
Diagnosed cancer type | ||||||
Gastric cancer | 22,417 | 7068 | 31.5 | 15,349 | 68.5 | <0.0001 |
Colorectal cancer | 22,636 | 6739 | 29.8 | 15,897 | 70.2 | |
Hepatocellular carcinoma | 6030 | 1951 | 32.4 | 4079 | 67.6 | |
Lung cancer | 13,422 | 4217 | 31.4 | 9205 | 68.6 | |
Charlson Comorbidity Index (excluded Cancer) | ||||||
~2 | 33,904 | 10,301 | 30.4 | 23,603 | 69.6 | <0.0001 |
3~5 | 15,337 | 4480 | 29.2 | 10,857 | 70.8 | |
6~ | 15,264 | 5194 | 34.0 | 10,070 | 66.0 | |
Died during observed year | ||||||
Yes | 6564 | 1936 | 29.5 | 4628 | 70.5 | 0.0065 |
No | 57,941 | 18,039 | 31.1 | 39,902 | 68.9 | □ |
Total | 64,505 | 19,975 | 31.0 | 44,530 | 69.0 | □ |
Variables | Treatment at Hospital Outside of Residing Area | |||
---|---|---|---|---|
OR | 95% CI | p-Value | ||
Residing area | ||||
Capital area | 1.000 | - | - | - |
Metropolitan cities | 0.938 | 0.866 | 1.015 | 0.1125 |
Provincial areas | 2.202 | 2.068 | 2.344 | <0.0001 |
Institution of main treatment | ||||
General hospital | 4.396 | 4.056 | 4.765 | <0.0001 |
Hospital | 2.118 | 1.891 | 2.373 | <0.0001 |
Long-term care hospital | 2.940 | 2.577 | 3.354 | <0.0001 |
Clinic | 1.000 | - | - | - |
Sex | ||||
Male | 1.000 | - | - | - |
Female | 1.071 | 1.014 | 1.132 | 0.0141 |
Age | ||||
~69 | 1.287 | 1.172 | 1.413 | <0.0001 |
70~74 | 1.304 | 1.219 | 1.395 | <0.0001 |
75~79 | 1.140 | 1.068 | 1.216 | <0.0001 |
80~ | 1.000 | - | - | - |
Type of insurance coverage | ||||
NHI self-employed | 0.578 | 0.515 | 0.649 | <0.0001 |
NHI employed | 0.880 | 0.829 | 0.935 | <0.0001 |
Medical Aid | 1.000 | - | - | - |
Economic status | ||||
Low | 1.000 | - | - | - |
Mid-low | 1.058 | 0.978 | 1.144 | 0.1589 |
Mid | 1.097 | 1.010 | 1.192 | 0.0273 |
Mid-high | 1.289 | 1.185 | 1.402 | <0.0001 |
High | 1.351 | 1.246 | 1.465 | <0.0001 |
Time since first diagnosis | ||||
~1 y | 1.221 | 1.138 | 1.310 | <0.0001 |
1~2 y | 1.176 | 1.101 | 1.256 | <0.0001 |
2~3 y | 1.133 | 1.065 | 1.205 | <0.0001 |
3~4 y | 1.012 | 0.957 | 1.069 | 0.6841 |
4~5 y | 1.000 | - | - | - |
Diagnosed cancer type | ||||
Gastric cancer | 1.000 | - | - | - |
Colorectal cancer | 0.985 | 0.922 | 1.052 | 0.6510 |
Hepatocellular carcinoma | 0.995 | 0.907 | 1.093 | 0.9223 |
Lung cancer | 0.996 | 0.927 | 1.069 | 0.9035 |
Charlson Comorbidity Index (excluded Cancer) | ||||
~2 | 1.114 | 1.055 | 1.176 | 0.0001 |
3~5 | 0.988 | 0.930 | 1.049 | 0.6844 |
6~ | 1.000 | - | - | - |
Died during observed year | ||||
Yes | 1.000 | - | - | - |
No | 1.379 | 1.291 | 1.472 | <0.0001 |
Year | 0.930 | 0.919 | 0.940 | <0.0001 |
Variables | Days of Care | Costs | ||||||
---|---|---|---|---|---|---|---|---|
RR | 95% CI | p-Value | RR | 95% CI | p-Value | |||
Treatment at hospital outside of residing area | ||||||||
Yes | 1.021 | 0.986 | 1.058 | 0.2431 | 1.054 | 1.017 | 1.093 | 0.0037 |
No | 1.000 | - | - | - | 1.000 | - | - | - |
Residential area | ||||||||
Capital area | 1.000 | - | - | - | 1.000 | - | - | - |
Metropolitan cities | 0.998 | 0.948 | 1.051 | 0.9439 | 1.007 | 0.960 | 1.056 | 0.7863 |
Provincial areas | 1.178 | 1.129 | 1.231 | <0.0001 | 1.002 | 0.961 | 1.044 | 0.9254 |
Types of main treatment institution | ||||||||
General hospital | 1.019 | 0.970 | 1.070 | 0.4598 | 3.111 | 2.949 | 3.282 | <0.0001 |
Hospital | 1.102 | 1.038 | 1.170 | 0.0015 | 2.471 | 2.312 | 2.641 | <0.0001 |
Long-term care hospital | 2.108 | 1.985 | 2.238 | <0.0001 | 7.396 | 6.854 | 7.980 | <0.0001 |
Clinic | 1.000 | - | - | - | 1.000 | - | - | - |
Sex | ||||||||
Male | 1.000 | - | - | - | 1.000 | - | - | - |
Female | 1.000 | 0.961 | 1.040 | 0.9953 | 0.969 | 0.934 | 1.004 | 0.0845 |
Age (years) | ||||||||
~69 | 1.000 | - | - | - | 1.000 | - | - | - |
70~74 | 0.887 | 0.828 | 0.951 | 0.0007 | 1.149 | 1.079 | 1.222 | <0.0001 |
75~79 | 0.920 | 0.874 | 0.968 | 0.0014 | 1.049 | 0.997 | 1.103 | 0.068 |
80~ | 0.966 | 0.921 | 1.013 | 0.1546 | 1.021 | 0.969 | 1.075 | 0.4408 |
Types of Insurance coverage | ||||||||
NHI self-employed | 1.178 | 1.095 | 1.268 | <0.0001 | 1.119 | 1.045 | 1.197 | 0.0012 |
NHI employed | 0.972 | 0.932 | 1.014 | 0.1936 | 0.966 | 0.929 | 1.004 | 0.0764 |
Medical-Aid | 1.000 | - | - | - | 1.000 | - | - | - |
Economic status | ||||||||
Low | 1.000 | - | - | - | 1.000 | - | - | - |
Mid-low | 0.980 | 0.925 | 1.037 | 0.478 | 1.070 | 1.007 | 1.138 | 0.0296 |
Mid | 0.980 | 0.923 | 1.041 | 0.5179 | 1.003 | 0.955 | 1.055 | 0.8975 |
Mid-high | 0.984 | 0.925 | 1.047 | 0.6071 | 0.990 | 0.939 | 1.044 | 0.7103 |
High | 0.969 | 0.914 | 1.028 | 0.299 | 1.043 | 0.991 | 1.097 | 0.1086 |
Period after first diagnosis | ||||||||
~1 y | 1.403 | 1.329 | 1.482 | <0.0001 | 2.877 | 2.685 | 3.082 | <0.0001 |
1~2 y | 1.015 | 0.973 | 1.058 | 0.4995 | 1.259 | 1.204 | 1.316 | <0.0001 |
2~3 y | 1.001 | 0.967 | 1.036 | 0.9451 | 1.120 | 1.073 | 1.169 | <0.0001 |
3~4 y | 1.025 | 0.998 | 1.053 | 0.0732 | 1.086 | 1.043 | 1.132 | <0.0001 |
4~5 y | 1.000 | - | - | - | 1.000 | - | - | - |
Types of cancer which diagnosed | ||||||||
Gastric cancer | 1.000 | - | - | - | 1.000 | - | - | - |
Colorectal cancer | 1.086 | 1.033 | 1.142 | 0.0013 | 1.065 | 1.018 | 1.115 | 0.0068 |
Hepatocellular carcinoma | 1.184 | 1.107 | 1.268 | <0.0001 | 1.323 | 1.244 | 1.406 | <0.0001 |
Lung cancer | 1.232 | 1.174 | 1.292 | <0.0001 | 1.188 | 1.132 | 1.247 | <0.0001 |
Charlson Comorbidity Index (excluded Cancer) | ||||||||
~2 | 0.552 | 0.530 | 0.574 | <0.0001 | 0.404 | 0.387 | 0.423 | <0.0001 |
3~5 | 0.769 | 0.741 | 0.799 | <0.0001 | 0.625 | 0.600 | 0.650 | <0.0001 |
6~ | 1.000 | - | - | - | 1.000 | - | - | - |
Died in the observed year | ||||||||
Dead | 1.000 | - | - | - | 1.000 | - | - | - |
Alive | 0.398 | 0.386 | 0.412 | <0.0001 | 0.171 | 0.161 | 0.180 | <0.0001 |
Year | 0.989 | 0.980 | 0.998 | 0.0 | 1.078 | 1.066 | 1.091 | <0.0001 |
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Kim, W.; Han, K.-T.; Kim, S. Do Patients Residing in Provincial Areas Transport and Spend More on Cancer Treatment in Korea? Int. J. Environ. Res. Public Health 2021, 18, 9247. https://doi.org/10.3390/ijerph18179247
Kim W, Han K-T, Kim S. Do Patients Residing in Provincial Areas Transport and Spend More on Cancer Treatment in Korea? International Journal of Environmental Research and Public Health. 2021; 18(17):9247. https://doi.org/10.3390/ijerph18179247
Chicago/Turabian StyleKim, Woorim, Kyu-Tae Han, and Seungju Kim. 2021. "Do Patients Residing in Provincial Areas Transport and Spend More on Cancer Treatment in Korea?" International Journal of Environmental Research and Public Health 18, no. 17: 9247. https://doi.org/10.3390/ijerph18179247