Kang Jin Young, Kwon Jinhee, Sohn Chang Hwan, Kim Youn-Jung, Lim Hyo Won, Lee Seung Joon, Kim Won Young, Kim Namkug, Seo Dong-Woo
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Healthc Inform Res. 2020 Jan;26(1):34-41. doi: 10.4258/hir.2020.26.1.34. Epub 2020 Jan 31.
Foreign patients are more likely to receive inappropriate health service in the emergency room. This study aimed to investigate whether there is health inequality between foreigners and natives who visited emergency rooms with injuries and to examine its causes.
We analyzed clinical data from the National Emergency Department Information System database associated with patients of all age groups visiting the emergency room from 2013 to 2015. We analyzed data regarding mortality, intensive care unit admission, emergency operation, severity, area, and transfer ratio.
A total of 4,464,603 cases of injured patients were included, of whom 67,683 were foreign. Injury cases per 100,000 population per year were 2,960.5 for native patients and 1,659.8 for foreign patients. Foreigners were more likely to have no insurance (3.1% vs. 32.0%, < 0.001). Serious outcomes (intensive care unit admission, emergency operation, or death) were more frequent among foreigners. In rural areas, the difference between serious outcomes for foreigners compared to natives was greater (3.7% for natives vs. 5.0% for foreigners, < 0.001). The adjusted odds ratio for serious outcomes for foreign nationals was 1.412 (95% confidence interval [CI], 1.336-1.492), and that for lack of insurance was 1.354 (95% CI, 1.314-1.394).
Injured foreigners might more frequently suffer serious outcomes, and health inequality was greater in rural areas than in urban areas. Foreign nationality itself and lack of insurance could adversely affect medical outcomes.
外国患者在急诊室更有可能接受不适当的医疗服务。本研究旨在调查在急诊室就诊的受伤外国人与本国居民之间是否存在健康不平等，并探究其原因。
我们分析了2013年至2015年期间国家急诊科信息系统数据库中与各年龄段急诊室就诊患者相关的临床数据。我们分析了有关死亡率、重症监护病房收治率、急诊手术、严重程度、地区和转诊率的数据。
共纳入4464603例受伤患者，其中67683例为外国人。本国患者每年每10万人口中的受伤病例数为2960.5例，外国患者为1659.8例。外国人更有可能没有保险（3.1%对32.0%，<0.001）。外国人中严重后果（入住重症监护病房、急诊手术或死亡）更为常见。在农村地区，外国人与本国居民相比，严重后果的差异更大（本国居民为3.7%，外国人为5.0%，<0.001）。外国国民出现严重后果的调整优势比为1.412（95%置信区间[CI]，1.336 - 1.492），没有保险的调整优势比为1.354（95%CI，1.314 - 1.394）。
受伤的外国人可能更频繁地遭受严重后果，农村地区的健康不平等比城市地区更大。外国国籍本身和缺乏保险可能对医疗结果产生不利影响。
