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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2018.702    [Accepted]
The Effect of Disability on the Diagnosis and Treatment of Multiple Myeloma in Korea: A National Cohort Study
Jihyun Kwon1, So Young Kim2,3,4, Kyoung Eun Yeob3, Hye Sook Han1,5, Ki Hyeong Lee1,5, Dong Wook Shin6,7, Yeon-Yong Kim8, Jong Heon Park8, Jong Hyock Park3,4
1Division of Hematology-Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
2Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Korea
33Graduate School of Health Science Business Convergence, Chungbuk National University College of Medicine, Cheongju, Korea
4T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
5Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
6Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Seoul, Korea
7Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
8Big Data Steering Department, National Health Insurance Service, Wonju, Korea
Correspondence  Jong Hyock Park ,Tel: 82-43-261-2873, Fax: 82- 43-261-3459, Email: jonghyock@gmail.com
Received: December 19, 2018;  Accepted: April 21, 2019.  Published online: April 22, 2019.
*Jihyun Kwon and So Young Kim contributed equally to this work.
ABSTRACT
Purpose
This study aimed to determine whether the diagnosis, treatment approach and prognosis of multiple myeloma (MM) vary according to the presence and type of disability.
Materials and Methods
Demographic, socioeconomic, and medical data were obtained from the National Disability Database, the Korean Central Cancer Registry, and the Korean National Health Insurance claims database. An age- and sex-matched cohort was established using a 1:3 ratio constituted with 2,776,450 people with disabilities and 8,329,350 people without disabilities. Adult patients diagnosed with MM were subsequently selected from this cohort. Disabilities were categorized as physical, communication, intellectual or psychological, and affecting the major internal organs.
Results
The cohort included 4,090 patients with MM, with a significantly lower rate per 100,000 persons among people with disabilities than among people without disabilities (29.1 vs. 39.4, p<0.001). People with disabilities were more likely to undergo dialysis treatment at the time of diagnosis (16.3% vs. 10.0%, p<0.001), but were less likely to undergo autologous stem cell transplantation (37.5% vs. 43.7%, p=0.072). This trend was more evident among patients with intellectual or psychological disabilities. The median overall survival among patients with disabilities was significantly shorter than that among patients without disabilities (36.8 months vs 51.2 months, p<0.001)
Conclusion
In Korea, people with disabilities generally have a lower rate of MM diagnosis, receive less intensive treatment, and have a lower survival rate than people without disabilities.
Key words: Disability, Multiple myeloma, Cohort, Survival
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