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Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China.


ABSTRACT:

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.

SUBMITTER: Gu HQ 

PROVIDER: S-EPMC6074626 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China.

Gu Hong-Qiu HQ   Li Zi-Xiao ZX   Zhao Xing-Quan XQ   Liu Li-Ping LP   Li Hao H   Wang Chun-Juan CJ   Yang Xin X   Rao Zhen-Zhen ZZ   Wang Chun-Xue CX   Pan Yue-Song YS   Wang Yi-Long YL   Wang Yong-Jun YJ  

BMJ open 20180801 7


<h4>Objective</h4>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.<h4>Methods</h4>We abstracted 24 941 patients with acute stroke and TIA from the China National Stroke Registry II. In  ...[more]

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