Health Insurance and Colorectal Cancer Survival in Khon Kaen, Thailand

Document Type: Research Articles

Authors

1 Doctor of Philosophy Program in Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.

2 ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Khon Kaen, Thailand.

3 Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

4 Division of Oncology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

5 Department of Public Health Administration Health Promotion Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.

6 Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Abstract

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

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