Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database
| Autor: | Chi-Hsun Hsieh, Shao-Wei Chen, Ling-Wei Kuo, Chien-An Liao, Chih-Yuan Fu, Chien-Hung Liao, Shang-Yu Wang, Chi-Tung Cheng |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Multivariate analysis inequality Databases Factual Taiwan Logistic regression relative poverty Cohort Studies 03 medical and health sciences Young Adult 0302 clinical medicine Universal Health Insurance Medicine Humans 030212 general & internal medicine Risk factor National Health Insurance Healthcare Disparities Single-Payer System Socioeconomic status Original Research Aged Retrospective Studies business.industry 030208 emergency & critical care medicine Retrospective cohort study General Medicine Middle Aged trauma Injury Severity Score Wounds and Injuries Observational study Surgery Female business Demography Cohort study |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | ObjectivesTo assess the impact of lower socioeconomic status on the outcome of major torso trauma patients under the single-payer system by the National Health Insurance (NHI) in Taiwan.DesignA nationwide, retrospective cohort study.SettingAn observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI.ParticipantsPatients with major torso trauma (injury severity score ≥16) from 2003 to 2013 in Taiwan were included. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify trauma patients. A total of 64 721 patients were initially identified in the NHIRD. After applying the exclusion criteria, 20 009 patients were included in our statistical analysis.Primary and secondary outcome measuresThe primary outcome measure was in-hospital mortality, and we analysed patients with different income levels and geographic regions. Multiple logistic regression was used to control for confounding variables.ResultsIn univariate analysis, geographic disparities and low-income level were both risk factors for in-hospital mortality for patients with major torso trauma (p=0.002 and ConclusionEven with the NHI, wealth inequity still led to different outcomes for major torso trauma in Taiwan. Health policies must focus on this vulnerable group to eliminate inequality in trauma care. |
| Databáze: | OpenAIRE |
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