Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China.
Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China.
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DOI：
10.1136/bmjopen-2017-021334
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发表时间：
2018-08-01
期刊：
影响因子：
2.9
通讯作者：
China National Stroke Registries
中科院分区：
文献类型：
--
作者：
Gu HQ;Li ZX;Zhao XQ;Liu LP;Li H;Wang CJ;Yang X;Rao ZZ;Wang CX;Pan YS;Wang YL;Wang YJ;China National Stroke Registries
尽管中国超过95%的人口参加了城乡保险计划，但很少有研究对急性脑卒中和短暂性脑缺血发作（TIA）患者的保险相关结局差异进行研究。本研究的目的是检查保险状况与卒中和TIA患者1年结局之间的关系。我们从中国国家卒中登记中心II中抽取了24941例急性卒中和TIA患者。参保方式分为城镇基本医疗保险、新型农村合作医疗和自费三种。使用考克斯模型中的共享虚弱模型或考虑医院聚集效应的广义估计方程，分析保险状态与1年结局（包括全因死亡、卒中复发和残疾）之间的关系。基本医疗保险制度覆盖率为50%，新型农村合作医疗制度覆盖率为41.2%，自费医疗制度覆盖率为8.9%。与UBMIS覆盖的患者相比，新型农村合作医疗覆盖的患者的全因死亡风险显著更高（9.7% vs 8.6%，校正HR：1.32（95% CI 1.17至1.48），p<0.001），卒中复发（7.2% vs 6.5%，校正HR：1.12（95% CI 1.11至1.37），p<0.001）和残疾（32.0% vs 26.3%，校正OR：1.29（95% CI 1.21至1.39），p<0.001）。与UBMIS覆盖的患者相比，自费患者的死亡和中风复发风险相似，但残疾风险较高。脑卒中和TIA患者1年死亡率、脑卒中复发率和残疾率在城乡医保人群中存在差异。
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. 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. 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. Patients with stroke and TIA demonstrated differences in 1-year mortality, stroke recurrence and disability between urban and rural insurance groups in China.
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DOI：
10.2471/blt.08.053413
发表时间：
2008-11-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
McIntyre, Diane;Garshong, Bertha;Goudge, Jane
通讯作者：
Goudge, Jane
影响因子：
8.3
作者：
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通讯作者：
Wang, Yongjun
影响因子：
4.1
作者：
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通讯作者：
Rahman, Maryam
影响因子：
3
作者：
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通讯作者：
Martin, Diane P.
影响因子：
48
作者：
Strong, Kathleen;Mathers, Colin;Bonita, Ruth
通讯作者：
Bonita, Ruth