Department of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Disabil Health J. 2024 Jul;17(3):101596. doi: 10.1016/j.dhjo.2024.101596. Epub 2024 Feb 26.
The onset of disability is a major health challenge, and people with disability can be particularly underserved in the years immediately after the disability onset.
To analyze the excess mortality rate of people with recent-onset disability and their health-care utilization during the period after disability onset (1-6 years after onset).
We used whole-population claims data from 2015 to 2020 (for approximately 23 million individuals) from Taiwan's National Health Insurance (NHI) system. These NHI claims data were linked to the National Death Records and National Disability Registry. Each individual with a disability was followed until their death or December 31, 2020. The age-standardized mortality rate and outpatient and inpatient utilization were compared between individuals with and without disability. Finally, Cox regressions were estimated to determine excess mortality for the individuals with disability.
The age-standardized mortality rates for the people with disability and those without disability were 1020.35/10,000 and 463.83/10,000, respectively. The people with disability utilized significantly more medical care under the NHI system. Mortality rates differed substantially among disability types. The Cox regression revealed a hazard ratio of 1.47 (95% CI = 1.46, 1.48) for all-cause mortality for people with disability, and significant sex differences in mortality risk were observed for some causes of death.
According to the excess mortality rates within 6 years of disability onset observed in this study, the NHI may not be sufficient to reduce health disparity between people with and without disabilities. In addition, specific characteristics of each type of disability should be considered.
残疾的发生是一个主要的健康挑战，残疾人士在残疾发生后的头几年可能得不到充分的服务。
分析近期发生残疾的人群的超额死亡率以及他们在残疾发生后（发病后 1-6 年）期间的医疗保健利用情况。
我们使用了来自台湾全民健康保险（NHI）系统的 2015 年至 2020 年（约 2300 万人）的全人群索赔数据。这些 NHI 索赔数据与国家死亡记录和国家残疾登记处相链接。每个残疾个体都被随访，直到他们死亡或 2020 年 12 月 31 日。比较残疾个体和非残疾个体的年龄标准化死亡率和门诊及住院利用率。最后，使用 Cox 回归来确定残疾个体的超额死亡率。
残疾个体和非残疾个体的年龄标准化死亡率分别为 1020.35/10,000 和 463.83/10,000。残疾个体在 NHI 系统下使用了更多的医疗保健。不同残疾类型的死亡率差异很大。Cox 回归显示，残疾个体的全因死亡率的危险比为 1.47（95%CI=1.46，1.48），某些死因的死亡率存在显著的性别差异。
根据本研究中残疾发病后 6 年内观察到的超额死亡率，NHI 可能不足以减少残疾人和非残疾人之间的健康差距。此外，应考虑每种残疾类型的具体特征。
