The effects of socioeconomic and geographic factors on chronic phase long-term survival after stroke in South Korea

Abstract

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.

Accessibility for Rehabilitation Therapy According to Socioeconomic Status in Patients With Stroke: A Population-Based Retrospective Cohort Study

“…Stroke is a major public health problem as the population is ageing worldwide. There have been several studies to investigate the association between SES and stroke incidence and related-mortality, which suggested that incidence and mortality of stroke was increased in individuals with socioeconomic deprivation [ 15 16 17 18 ]. In addition, functional recovery after stroke has shown the relationship with socioeconomic deprivation [ 19 20 ].…”

Effect of Pre-Antibiotic Use Before First Stroke Incidence on Recurrence and Mortality: A Longitudinal Study Using the Korean National Health Insurance Service Database

“…We attempted to adjust for variables consistently available in our database among the confounding factors related to stroke prognosis identified in previous studies. [19][20][21][22] Socioeconomic status was defined as the level of household income divided into three groups based on the health insurance premium quartiles (Level 1: 1st-7th quartiles; Level 2: 8th-14th quartiles; and Level 3: 15th-20th quartiles). Comorbidities, such as hypertension, diabetes, and dyslipidemia, were identified using medication claims and health screening data.…”