Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China
First author：Hong-Qiu Gu,Zi-Xiao Li
Corresponding author：Yong-Jun Wang
essential_information
- Person in charge：Hong-Qiu Gu,Zi-Xiao Li
- Data Sources： CNSR-I
- Number of papers：CNSR-I20160067
- Published time：2018-08-08
2018-08-08
Published articles
Journal：BMJ Open
Publication type: Original Contributions
IF(IF): 2.692
PMID: 30068612 Link To Pubmed Full text Download
Background And Purpose
Despite well-documented discrepancies of treatments and outcomes in patients with stroke across insurance status in western countries, limited research has examined insurance-related disparities for patients with stroke in China. We sought to explore the disparities from a multi-hospital, community-wide perspective cohort though China National Stroke Registry Study II (CNSR II).
Method
1) Describe and compare the characteristic of population by insurance status (Chi square test, ANOVA , Wilcoxon rank sum,Kruskal-Wallis ) 2) Describe and compare the characteristic of hospitals by insurance status(Chi square test, ANOVA , Wilcoxon rank sum,Kruskal-Wallis) 3) Assess the association between treatment disparities and insurance status(Chi square test, logistic regression) 4) Assess the association between outcome disparities and insurance status(Chi square test, logistic regression, cox regression)
Conclusion
Patients with stroke and TIA demonstrated differences in 1-year mortality, stroke recurrence and disability between urban and rural insurance groups in China.
Main results
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.