Abstract
The stroke incidence has increased rapidly in South Korea, calling for a national-wide system for long-term stroke management. We investigated the effects of socioeconomic status (SES) and geographic factors on chronic phase survival after stroke. We retrospectively enrolled 6994 patients who experienced a stroke event in 2009 from the Korean National Health Insurance database. We followed them up from 24 to 120 months after stroke onset. The endpoint was all-cause mortality. We defined SES using a medical-aid group and four groups divided by health insurance premium quartiles. Geographic factors were defined using Model 1 (capital, metropolitan, city, and county) and Model 2 (with or without university hospitals). The higher the insurance premium, the higher the survival rate tended to be (P < 0.001). The patient survival rate was highest in the capital city and lowest at the county level (P < 0.001). Regions with a university hospital(s) showed a higher survival rate (P = 0.006). Cox regression revealed that the medical-aid group was identified as an independent risk factor for chronic phase mortality. Further, NHIP level had a more significant effect than geographic factors on chronic stroke mortality. From these results, long-term nationwide efforts to reduce inter-regional as well as SES discrepancies affecting stroke management are needed.
Highlights
Along with population aging, the prevalence of stroke is on the rise
Baseline characteristics according to national health insurance premium (NHIP) levels
The ratio of patients over 80 was highest in the medicalaid group (28.96%), and over 70 was highest (72.42%) in the 4th quartile group, which had the highest NHIP level when compared to the other groups (P < 0.001)
Summary
The prevalence of stroke is on the rise. The American Heart Association represented the global prevalence of cerebrovascular disease (CVD) was 101.5 million people, and CVD attributed to 6.6 million deaths in 20191. According to statistics on the causes of deaths released by the Korean National Statistical Office, 42 deaths per 100,000 people were due to CVD as of 2019 and is ranked fourth as the cause of death after malignant neoplasms, cardiovascular diseases, and p neumonia[3] This aging population and the accompanying increase in CVD prevalence generate an increasingly onerous socioeconomic burden[4]. Employed insurance is only based on earned income, while self-employed insurance is based on unearned income, real estate, and car o wnership[15] Based on these assumptions, this study attempted to analyze the effects of national health insurance premium (NHIP) level and residential area (serving as proxy indicators of socioeconomic and geographic factors, respectively) on chronic phase long-term survival in patients with stroke.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
