ArticleInternational journal for equity in health2025
Impact of fragmented care on cancer outcomes among korean women with breast and cervical cancer: a focus on regional and economic disparities.
Article in International journal for equity in health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe patterns of breast and cervical cancers have improved owing to national cancer control over the past decades, but the disparity in medical resources and increasing number of patients with cancer in the capital area have worsened. Previous studies have revealed the association of fragmented care (FC) with health disparities; however, studies have been lacking in women's cancers and outcomes. The study aims to examine the impact of FC in women with breast and cervical cancers and compare them according to health disparity factors.
methodsData used from the National Health Insurance (NHI) claim data from 2011 to 2021. Female patients with cancer aged ≥ 30 years were selected as the participants. The final population-based sample included 84,931 patients with breast cancer and 14,520 patients with cervical cancer. Regression and survival analyses were conducted to investigate the associations between length of stay (LOS), medical expenditure, 5-year mortality, and FC. Subgroup analyses were performed based on residential areas, type of hospital with major cancer treatment, and economic level to compare differences in the association with FC.
resultsOf the 84,931 patients with breast cancer and 14,520 with cervical cancer, 13,946 (16.4%) and 1,674 (11.5%) experienced FC, respectively. The LOS (Breast: RR 1.18, 95% CI 1.14-1.23; Cervical: RR 1.47, 95% CI 1.33-1.61) and medical expenditure (Breast: RR 1.08, 95% CI 1.07-1.10; Cervical: RR 1.49, 95% CI 1.39-1.59) were higher for patients with FC compared to those without. Higher risk of mortality was observed among patients with cervical cancer with FC (HR 1.48, 95% CI 1.33-1.65), but no significant association was observed in breast cancer (HR 0.95, 95% CI 0.87-1.03). These associations were greater in patients who lived in metropolitan areas, had a low economic status, or visited low-level hospitals.
conclusionFC can negatively affect the efficiency of healthcare delivery, resulting in excessive medical expenditures and deterioration of health outcomes. These associations may be greater under conditions of disparities in cancer care such as accessibility.
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