Department of Rehabilitation Medicine, Brain and Vascular Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea.
Department of Neurology, Brain and Vascular Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea.
Sci Rep. 2022 Mar 14;12(1):4327. doi: 10.1038/s41598-022-08025-2.
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.
韩国的中风发病率迅速上升，需要建立一个全国性的长期中风管理系统。我们研究了社会经济地位（SES）和地理因素对中风后慢性期生存的影响。我们回顾性地招募了 2009 年从韩国国家健康保险数据库中发生中风事件的 6994 名患者。我们从中风发作后 24 到 120 个月对他们进行了随访。终点是全因死亡率。我们使用医疗补助组和按健康保险保费四分位数划分的四个组来定义 SES。地理因素使用模型 1（首都、大都市、城市和县）和模型 2（有或没有大学医院）来定义。保险费越高，生存率越高（P<0.001）。首都的患者生存率最高，县的生存率最低（P<0.001）。有大学医院的地区生存率更高（P=0.006）。Cox 回归显示，医疗补助组是慢性期死亡率的独立危险因素。此外，NHIP 水平对慢性中风死亡率的影响比地理因素更显著。从这些结果来看，需要在全国范围内长期努力，减少影响中风管理的地区间和 SES 差异。
