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Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China
OBJECTIVE: Although more than 95% of the population is insured by urban or rural insurance programmes in China, little research has been done on insurance-related outcome disparities for patients with acute stroke and transient ischaemic attack (TIA). This study aimed to examine the relationship bet...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074626/ https://www.ncbi.nlm.nih.gov/pubmed/30068612 http://dx.doi.org/10.1136/bmjopen-2017-021334 |
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author | Gu, Hong-Qiu Li, Zi-Xiao Zhao, Xing-Quan Liu, Li-Ping Li, Hao Wang, Chun-Juan Yang, Xin Rao, Zhen-Zhen Wang, Chun-Xue Pan, Yue-Song Wang, Yi-Long Wang, Yong-Jun |
author_facet | Gu, Hong-Qiu Li, Zi-Xiao Zhao, Xing-Quan Liu, Li-Ping Li, Hao Wang, Chun-Juan Yang, Xin Rao, Zhen-Zhen Wang, Chun-Xue Pan, Yue-Song Wang, Yi-Long Wang, Yong-Jun |
author_sort | Gu, Hong-Qiu |
collection | PubMed |
description | OBJECTIVE: Although more than 95% of the population is insured by urban or rural insurance programmes in China, little research has been done on insurance-related outcome disparities for patients with acute stroke and transient ischaemic attack (TIA). This study aimed to examine the relationship between insurance status and 1-year outcomes for patients with stroke and TIA. METHODS: We abstracted 24 941 patients with acute stroke and TIA from the China National Stroke Registry II. Insurance status was categorised as Urban Basic Medical Insurance Scheme (UBMIS), New Rural Cooperative Medical Scheme (NRCMS) and self-payment. The relationship between insurance status and 1-year outcomes, including all-cause death, stroke recurrence and disability, was analysed using the shared frailty model in the Cox model or generalised estimating equation with consideration of the hospital’s cluster effect. RESULTS: About 50% of patients were covered by UBMIS, 41.2% by NRCMS and 8.9% by self-payment. Compared with patients covered by UBMIS, patients covered by NRCMS had a significantly higher risk of all-cause death (9.7% vs 8.6%, adjusted HR: 1.32 (95% CI 1.17 to 1.48), p<0.001), stroke recurrence (7.2% vs 6.5%, adjusted HR: 1.12 (95% CI 1.11 to 1.37), p<0.001) and disability (32.0% vs 26.3%, adjusted OR: 1.29 (95% CI 1.21 to 1.39), p<0.001). Compared with patients covered by UBMIS, self-payment patients had a similar risk of death and stroke recurrence but a higher risk of disability. CONCLUSIONS: Patients with stroke and TIA demonstrated differences in 1-year mortality, stroke recurrence and disability between urban and rural insurance groups in China. |
format | Online Article Text |
id | pubmed-6074626 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-60746262018-08-09 Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China Gu, Hong-Qiu Li, Zi-Xiao Zhao, Xing-Quan Liu, Li-Ping Li, Hao Wang, Chun-Juan Yang, Xin Rao, Zhen-Zhen Wang, Chun-Xue Pan, Yue-Song Wang, Yi-Long Wang, Yong-Jun BMJ Open Health Services Research OBJECTIVE: Although more than 95% of the population is insured by urban or rural insurance programmes in China, little research has been done on insurance-related outcome disparities for patients with acute stroke and transient ischaemic attack (TIA). This study aimed to examine the relationship between insurance status and 1-year outcomes for patients with stroke and TIA. METHODS: We abstracted 24 941 patients with acute stroke and TIA from the China National Stroke Registry II. Insurance status was categorised as Urban Basic Medical Insurance Scheme (UBMIS), New Rural Cooperative Medical Scheme (NRCMS) and self-payment. The relationship between insurance status and 1-year outcomes, including all-cause death, stroke recurrence and disability, was analysed using the shared frailty model in the Cox model or generalised estimating equation with consideration of the hospital’s cluster effect. RESULTS: About 50% of patients were covered by UBMIS, 41.2% by NRCMS and 8.9% by self-payment. Compared with patients covered by UBMIS, patients covered by NRCMS had a significantly higher risk of all-cause death (9.7% vs 8.6%, adjusted HR: 1.32 (95% CI 1.17 to 1.48), p<0.001), stroke recurrence (7.2% vs 6.5%, adjusted HR: 1.12 (95% CI 1.11 to 1.37), p<0.001) and disability (32.0% vs 26.3%, adjusted OR: 1.29 (95% CI 1.21 to 1.39), p<0.001). Compared with patients covered by UBMIS, self-payment patients had a similar risk of death and stroke recurrence but a higher risk of disability. CONCLUSIONS: Patients with stroke and TIA demonstrated differences in 1-year mortality, stroke recurrence and disability between urban and rural insurance groups in China. BMJ Publishing Group 2018-08-01 /pmc/articles/PMC6074626/ /pubmed/30068612 http://dx.doi.org/10.1136/bmjopen-2017-021334 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Health Services Research Gu, Hong-Qiu Li, Zi-Xiao Zhao, Xing-Quan Liu, Li-Ping Li, Hao Wang, Chun-Juan Yang, Xin Rao, Zhen-Zhen Wang, Chun-Xue Pan, Yue-Song Wang, Yi-Long Wang, Yong-Jun Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China |
title | Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China |
title_full | Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China |
title_fullStr | Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China |
title_full_unstemmed | Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China |
title_short | Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China |
title_sort | insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in china |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074626/ https://www.ncbi.nlm.nih.gov/pubmed/30068612 http://dx.doi.org/10.1136/bmjopen-2017-021334 |
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