Piao Zhaoyan, Choi Heekyoung, Jeon Boyoung, Han Euna
College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 162-1 Songdo-dong, Yeonsu-gu, Incheon, South Korea.
Division of Infectious Diseases, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, 100 ilsan-ro ilsan-donggu Goyang-si Gyeonggi-do, 10444, South Korea.
Int J Qual Health Care. 2025 Jul 4;37(3). doi: 10.1093/intqhc/mzaf045.
Persons with disabilities often encounter barriers in accessing healthcare services. However, research on the impact of disability on the continuity of care (COC) remains limited. We assessed the changes in COC among disabled individuals to monitor alterations in their healthcare accessibility.
This study used the National Health Insurance Service-National Sample Cohort 2.0 DB. The Bice-Boxerman COC Index (COCI; 0-1 range; higher values indicate greater COC) was used, with disability status of the participants determined from the registered data. Propensity-score matching was conducted for the control group. Difference-in-difference analysis was conducted to evaluate pre- and post-disability changes in COC for people with disabilities relative to those without.
COCI values were analyzed for 9702 participants with disabilities and 19 404 control individuals. On average, the disability group scored 0.0343 lower than the control group 1 year before disability registration (P = .001) relative to the disability registration year. Similar results were obtained for the physical disability, visual disability, and hearing disability subgroups, with scores of -0.0342, -0.0394, and -0.0285, respectively (P < .0001 for all groups). On the other hand, the neurological disability subgroup showed a marginal change in the COCI score, peaking 2 years before disability registration (-0.0757, P < .0001).
Individuals with physical, visual, and hearing disabilities showed low COCI scores, with a significant decline occurring 1 year before disability registration. In contrast, the control group showed no change in COC. This result highlights the need to improve healthcare continuity, particularly for individuals with the respective disabilities.
残疾人在获得医疗服务时常常遇到障碍。然而，关于残疾对医疗连续性（COC）影响的研究仍然有限。我们评估了残疾个体的医疗连续性变化，以监测其医疗可及性的改变。
本研究使用了国民健康保险服务-全国样本队列2.0数据库。采用比塞-博克斯曼医疗连续性指数（COCI；范围为0至1；分数越高表明医疗连续性越好），根据登记数据确定参与者的残疾状况。对对照组进行倾向得分匹配。进行差异分析以评估残疾人相对于非残疾人在残疾前后医疗连续性的变化。
对9702名残疾参与者和19404名对照个体的COCI值进行了分析。平均而言，在残疾登记前1年，残疾组的得分相对于残疾登记年份比对照组低0.0343（P = 0.001）。身体残疾、视力残疾和听力残疾亚组也得到了类似结果，得分分别为-0.0342、-0.0394和-0.0285（所有组P < 0.0001）。另一方面，神经残疾亚组的COCI得分变化较小，在残疾登记前2年达到峰值（-0.0757，P < 0.0001）。
身体、视力和听力残疾个体的COCI得分较低，在残疾登记前1年出现显著下降。相比之下，对照组的医疗连续性没有变化。这一结果凸显了改善医疗连续性的必要性，特别是对于患有相应残疾的个体。
