The Transfer Patterns of Vulnerable Populations with Acute Cardio-Cerebrovascular Diseases

Abstract

Abstract Background In Korea, cardio-cerebrovascular diseases (CCDs) are the second leading cause of death. As providing appropriate treatment within the golden hour is crucial for managing acute onset CCDs, health outcomes vary depending on the accessibility of hospital. This study aimed to investigate the healthcare accessibility of vulnerable populations based on the transfer patterns with acute CCDs. Methods We analyzed the transfer times to final treatment hospital using the Korean National Health Insurance claim database from 2016 to 2021. We used multivariate logistic regression analysis on whether patients were transferred between hospitals after adjusting for age, gender, income level, and residence. Results The risk of transfer between hospitals was lower in socially vulnerable groups (elderly, low-income groups, and people with disabilities) compared to other groups (adjusted Odds Ratio [aOR]=0.65; 95% Confidence Interval [CI] 0.64-0.67 for people with disabilities vs people without disabilities), while it was higher in geographically vulnerable groups (rural) compared to other groups (aOR=2.05; [CI] 2.01-2.09 for rural vs metropolitan). Additionally, people with mild disabilities and those with visual, hearing, language, or physical disabilities showed higher transfer risk compared to other groups. Conclusions The risk of transfer showed opposite patterns between the two vulnerable groups with high mortality rates. The geographically vulnerable group had a higher risk due to absence treatable hospitals, while the socially vulnerable group might not have transferred even when it was necessary due to economic and physical constraints. The possibility of transfer was higher among the high-income group, which was assumed to be transferred to hospitals with better medical services. In fact, among patients hospitalized at teaching hospitals, 40% belong to the top 20% of income level. Efforts to improve accessibility for all in medical services should be continued. Key messages • The risk of being transferred between hospitals showed opposite patterns between socially vulnerable and geographically vulnerable groups with high mortality rates. • Measures are needed to improve access to quality hospitals, and monitoring is necessary for situations where necessary transfers are not carried out.