Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database
Objectives To 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.Design A nationwide, retrospective cohort study.Setting An observational study from the NHI Research Database...
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BMJ Publishing Group
2019-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/11/e032062.full |
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| author | Ling-wei Kuo Chih-Yuan Fu Chien-An Liao Chien-Hung Liao Chi-Hsun Hsieh Shang-Yu Wang Shao-Wei Chen Chi-Tung Cheng |
| author_facet | Ling-wei Kuo Chih-Yuan Fu Chien-An Liao Chien-Hung Liao Chi-Hsun Hsieh Shang-Yu Wang Shao-Wei Chen Chi-Tung Cheng |
| author_sort | Ling-wei Kuo |
| collection | DOAJ |
| description | Objectives To 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.Design A nationwide, retrospective cohort study.Setting An observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI.Participants Patients 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 measures The 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.Results In 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 <0.001, respectively). However, in multivariate analysis, only a low-income level remained an independent risk factor for increased in-hospital mortality (p<0.001).Conclusion Even 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. |
| format | Article |
| id | doaj-art-9d2abda33c4748a8b4467b0f1f35f1e3 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-9d2abda33c4748a8b4467b0f1f35f1e32024-11-29T21:50:08ZengBMJ Publishing GroupBMJ Open2044-60552019-11-0191110.1136/bmjopen-2019-032062Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research DatabaseLing-wei Kuo0Chih-Yuan Fu1Chien-An Liao2Chien-Hung Liao3Chi-Hsun Hsieh4Shang-Yu Wang5Shao-Wei Chen6Chi-Tung Cheng7Department of medicine, Chang Gung university, Taoyuan, TaiwanDepartment of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, TaiwanTrauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan1 Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, TaiwanTrauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan1 Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan2 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, TaiwanDepartment of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, TaiwanObjectives To 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.Design A nationwide, retrospective cohort study.Setting An observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI.Participants Patients 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 measures The 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.Results In 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 <0.001, respectively). However, in multivariate analysis, only a low-income level remained an independent risk factor for increased in-hospital mortality (p<0.001).Conclusion Even 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.https://bmjopen.bmj.com/content/9/11/e032062.full |
| spellingShingle | Ling-wei Kuo Chih-Yuan Fu Chien-An Liao Chien-Hung Liao Chi-Hsun Hsieh Shang-Yu Wang Shao-Wei Chen Chi-Tung Cheng Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database BMJ Open |
| title | Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database |
| title_full | Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database |
| title_fullStr | Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database |
| title_full_unstemmed | Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database |
| title_short | Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database |
| title_sort | inequality of trauma care under a single payer universal coverage system in taiwan a nationwide cohort study from the national health insurance research database |
| url | https://bmjopen.bmj.com/content/9/11/e032062.full |
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