国家神经系统疾病临床医学研究中心数据管理与共享系统

Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

《国家中心数据管理与共享系统操作说明书 —— 研究者部分》

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

第一作者：Hong-Qiu Gu,Zi-Xiao Li

通讯作者：Yong-Jun Wang

Stroke Insurance

基本信息

2018-08-08

已发表文章

发表杂志：BMJ Open

发表类型: Original Contributions

影响因子(IF): 2.692

PMID: 30068612 Pubmed原文链接 全文下载

主要研究背景及目的

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).

方法

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)

结论

Patients with stroke and TIA demonstrated differences in 1-year mortality, stroke recurrence and disability between urban and rural insurance groups in China.

主要结果

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.