Health care reform and stroke prognosis in low-income Chinese populations from 1992 to 2018.

To assess the impact of the health care reform on stroke prognoses among low-income Chinese residents. Stroke events and all-cause deaths were registered during 1992-2018 in Tianjin, China. Trends in stroke management and prognoses were compared during the study periods1992-2008 and 2009-2018. A total of 1462 patients were diagnosed with first-ever stroke during the study periods. For patients aged ≥45 years, the rates of neuroimaging-based diagnoses and hospitalization were greater in 2009-2018 than in 1992-2008, regardless of patient sex or stroke type. Overall, the one-year case fatality rate was significantly lower in 2009-2018 than in the earlier period; the case fatality rate for women aged ≥65 years decreased by 30.0%. Between both periods, the stroke recurrence rate increased 1.9-fold, including a 2.5-fold increase in men (all P < 0.05). During the 2009-2018 period, the one-year case fatality rate was higher among elderly male patients not using medical insurance than among those using it (32.8% vs 20.7%; P = 0.050). After 2009, a significant decline in the recurrence rate (P = 0.001) and a significant increase in the hospitalization rate (P = 0.004) were observed in the interrupted time-series analysis. These findings suggest that the implementation of universal medical insurance for residents in urban and rural China played a major role in improving the prognoses of low-income, rural, first-ever stroke patients, especially for elderly (≥65 years old) residents. However, elderly male patients not using medical insurance benefits had a high case fatality rate. Thus, restructuring of the government medical insurance policy to facilitate its use by low-income, rural residents is crucial for reducing the stroke burden in China. Copyright © 2021 by the Journal of Global Health. All rights reserved.

Citation

Jie Liu, Qiuxing Lin, Ying Gao, Xinxin Zhang, Dongwang Qi, Conglin Wang, Jun Tu, Yaogang Wang, Xianjia Ning, Jinghua Wang. Health care reform and stroke prognosis in low-income Chinese populations from 1992 to 2018. Journal of global health. 2021 Apr 17;11:08002

Mesh Tags

PMID: 33884194

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