Oesophageal cancer-specific mortality risk and public health insurance: Prospective cohort study from China

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.

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.

The χ ² 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.

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.

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.