Objective: Lymphoma, comprising Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL), is one of the common cancers worldwide.Little is known about how health insurance policies and self-paying rate influence lymphoma prognosis. Here, we examined the association between individual health insurance status and lymphoma-specific mortality in China.

Materials and Methods: A prospective longitudinal cohort study was conducted in Chongqing University Cancer Hospital, China from 2015 to 2021.The health insurance plan of patient was classified as either urban resident-based basic medical insurance (URBMI) or urban employee-based basic medical insurance (UEBMI) and was also categorized as self-paying rate (ie, the non-covered/ total charge) below or above the median.lymphoma-specific mortality was the primary outcome.After following the inclusion and exclusion criteria, the chi-square test was used to describe the demographic and clinical characteristics of patients with different insurance types and different self-paying rates. Multivariate logistic regression was used to analyze the relationship between patients with different insurance types, self-paying rates, and lymphoma treatment methods. Finally, the Cox proportional hazard model and the competitive risk model are used to calculate the cumulative hazard ratio of all-cause death and lymphoma-specific death for different insurance types and different self-paying rate groups.

Results:After following the inclusion and exclusion criteria, we included 2947 patients first diagnosed with lymphoma.We found that no matter patients received URBMI or UEBMI, they all more received treatment at the lymphoma later stage. After adjusting for clinical features and lymphoma treatment, compared with patients with insufficient self-paying rate, patients with a higher self-paying rate had a 54% lower risk of lymphoma-specific death (HRs = 0.460, 95%CI: 0.358-0.593, P < 0.001). Every 10% increase in self-paying rate of URBMI reduces the risk of lymphoma-specific death by 19.7%, while every 10% increase in self-paying rate of UEBMI reduces the risk of lymphoma-specific death by 30.2%.

Conclusions: Underinsured and poor patients face a higher risk of lymphoma-specific mortality in china.The National Medical Security Administration should, under the condition of limited medical insurance funds, try to include the original self-paid innovative anti-tumor drugs and Outpatient examinations into the national medical insurance coverage, at the same time, address the high cost of new anticancer medicines is urgent.This can not only reduce the mortality rate of lymphoma patients, but also reduce the family burden of lymphoma patients.

Disclosures

No relevant conflicts of interest to declare.

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2024
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