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 24941 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.
基金:
Ministry of Science and Technology of the People's Republic of ChinaMinistry of Science and Technology, China [2006BA101A11, 2008ZX09312-008, 2011BAI08B01, 2011BAI08B02, 2012ZX09303, 2013BAI09B14, 2013BAI09B03, 2015BAI12B02, 2015BAI12B04]; Beijing Municipal Commission of Science and Technology [D15110700200000, Z161100000516223]; Beijing Institute for Brain Disorders [BIBD-PXM2013_014226_07_000084]; Beijing Tiantan Hospital Seeding Initiative
第一作者机构:[1]China Natl Clin Res Ctr Neurol Dis, Beijing, Peoples R China;[2]Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Tiantan Clin Trial & Res Ctr Stroke, Beijing, Peoples R China;
通讯作者:
通讯机构:[1]China Natl Clin Res Ctr Neurol Dis, Beijing, Peoples R China;[2]Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Tiantan Clin Trial & Res Ctr Stroke, Beijing, Peoples R China;[3]Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Vasc Neurol, Beijing, Peoples R China;
推荐引用方式(GB/T 7714):
Gu Hong-Qiu,Li Zi-Xiao,Zhao Xing-Quan,et al.Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China[J].BMJ OPEN.2018,8(7):-.doi:10.1136/bmjopen-2017-021334.
APA:
Gu, Hong-Qiu,Li, Zi-Xiao,Zhao, Xing-Quan,Liu, Li-Ping,Li, Hao...&Wang, Yong-Jun.(2018).Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China.BMJ OPEN,8,(7)
MLA:
Gu, Hong-Qiu,et al."Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China".BMJ OPEN 8..7(2018):-