Abstract:
:OBJECTIVES: To assess the impact of lower socioeconomic status on the outcome of major torso trauma patients under the single-payer system by the National Health Insurance (NHI) in Taiwan. DESIGN: A nationwide, retrospective cohort study. SETTING: An observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI. PARTICIPANTS: Patients with major torso trauma (injury severity score ≥16) from 2003 to 2013 in Taiwan were included. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify trauma patients. A total of 64 721 patients were initially identified in the NHIRD. After applying the exclusion criteria, 20 009 patients were included in our statistical analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was in-hospital mortality, and we analysed patients with different income levels and geographic regions. Multiple logistic regression was used to control for confounding variables. RESULTS: In univariate analysis, geographic disparities and low-income level were both risk factors for in-hospital mortality for patients with major torso trauma (p=0.002 and <0.001, respectively). However, in multivariate analysis, only a low-income level remained an independent risk factor for increased in-hospital mortality (p<0.001). CONCLUSION: Even with the NHI, wealth inequity still led to different outcomes for major torso trauma in Taiwan. Health policies must focus on this vulnerable group to eliminate inequality in trauma care.
journal_name
BMJ Openjournal_title
BMJ openauthors
Kuo LW,Fu CY,Liao CA,Liao CH,Hsieh CH,Wang SY,Chen SW,Cheng CTdoi
10.1136/bmjopen-2019-032062subject
Has Abstractpub_date
2019-11-12 00:00:00pages
e032062issue
11issn
2044-6055pii
bmjopen-2019-032062journal_volume
9pub_type
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