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.
- transient ischemic attack
- health insurance
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H-QG and Z-XL contributed equally.
Contributors H-QG had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Y-LW and Y-JW initiated the study and obtained the funding. H-QG and Z-XL did the concept and design of this study. H-QG also performed the statistical analysis and drafted the manuscript. All the other authors including X-QZ, L-PL, HL, C-JW, XY, Z-ZR, C-XW and Y-SP participated in the acquisition, analysis or interpretation of data, and critical revision of the manuscript for valuable intellectual content.
Funding This work was supported by grants from the Ministry of Science and Technology of the People’s Republic of China (2006BA101A11, 2008ZX09312-008, 2011BAI08B01, 2011BAI08B02, 2012ZX09303, 2013BAI09B14, 2013BAI09B03, 2015BAI12B02 and 2015BAI12B04), Beijing Municipal Commission of Science and Technology (D15110700200000 and Z161100000516223), Beijing Institute for Brain Disorders (BIBD-PXM2013_014226_07_000084) and Beijing Tiantan Hospital Seeding Initiative.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The study was approved by the Central Institutional Review Board at Beijing Tiantan Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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