Exploring the relationship between urban-rural health disparities and post-acute rehabilitation care on ischemic stroke patients and mortality in Taiwan

研究背景與動機：健康不平等一直以來都是世界主要的研究議題之一，對於台灣醫療資源分布不均的情況下，健康不平等的課題即衍生出來。近年來，台灣腦中風皆高居十大死因中的第三位，而腦中風可能會遺留下不同程度且永久性的失能，因此在急性住院病人出院後會有連續性照護的需要。然而急性後期復健與腦中風病人死亡結果目前仍不明。 研究目的：透過本研究了解不同城鄉的缺血性腦中風病人與其一年內存活狀態的相關性，並探討急性後期缺血性腦中風病人接受急性後期復健照護與否與其一年內存活狀態的相關性。 研究方法：本研究利用全民健康保險研究資料庫2011年及2012年之百萬抽樣歸人檔做次級資料分析，依主診斷433、434以及436篩選於2011年首次因為缺血性腦中風住院之病患，並利用Cox比例風險模式(Cox proportional hazards model)探討缺血性腦中風病人城鄉健康不平等及急性後期復健與一年內存活狀態之相關性。 研究結果：研究樣本共有1456人，在城鄉健康不平等方面，相較居住於鄉村的缺血性腦中風病人，居住於都市的病人有較低的死亡風險比；在急性後期復健方面，缺血性腦中風病人每週復健頻率越頻繁者，其死亡風險也越低。 結論：相較居住於鄉村的病人，居住於都市的病人有較低的死亡風險比，因此可能需要多多關注鄉村地區病人資源匱乏或是醫療可近性的問題。由於每週復健頻率越高者，越能降低死亡風險，因此在適當的黃金治療期內積極進行復健治療確實可以改善缺血性腦中風病人之死亡風險。Background. Health disparity is one of the key research issues around the world. Because of the uneven distributions of medical resources in Taiwan, the issue of health disparity is derived. In recent years, stroke is the third leading place in Taiwan and it may leave varying degrees of permanent disability. Therefore, they may require continuity of care after acute inpatient discharge. However, the relationship between Post-Acute Care (PAC) and the death of stroke patients is still not clear. Objective. The aim of this study was to explore the association between urban-rural health disparities and post-acute rehabilitation care on ischemic stroke patients and 1 year mortality. Methods. This study used data from the nationwide representative sample through the National Health Insurance Research Database between 2011 and 2012. Patients who underwent first time admission in 2011 with a principal ICD-9-CM diagnosis codes 433, 434 and 436 were identified in this study. Cox proportional hazards model was conducted to examine the association between urban-rural health disparities and post-acute rehabilitation care on ischemic stroke patients and 1 year mortality. Results. There were 1456 patients included in this study. The study showed that compared with patients living in rural areas, patients living in urban tended to survive longer in a year. Moreover, as the frequency of rehabilitation increased, patients tended to survive longer in a year. Conclusion. Compared with patients living in rural areas, patients living in urban tended to survive longer in a year. Therefore, the importance of resource distribution and accessibility of medical care should be noticed. Meanwhile, patients should rehabilitate within 3 months after discharging from hospitals, and increased the frequency of rehabilitation