ABSTRACT
PURPOSE: The objective of this study was to investigate whether financial coverage by the national insurance system for patients with lower economic conditions can improve their 1-year mortality after intensive care unit (ICU) discharge. MATERIALS AND METHODS: This study, conducted in a single tertiary hospital, used a retrospective cohort design to investigate discharged ICU survivors between January 2012 and December 2016. ICU survivors were classified into two groups according to the National Health Insurance (NHI) system in Korea: medical aid program (MAP) group, including people who have difficulty paying their insurance premium or receive medical aid from the government due to a poor economic status; and NHI group consisting of people who receive government subsidy for approximately 2/3 of their medical expenses. RESULTS: After propensity score (PS) matching, a total of 2495 ICU survivors (1859 in NHI group and 636 in MAP group) were included in the analysis. Stratified Cox regression analysis of PS-matched cohorts showed that 1-year mortality was 1.31-fold higher in MAP group than in NHI group (hazard ratio: 1.31, 95% confidence interval, 1.06 to 1.61; p=0.012). According to Kaplan-Meir estimation, MAP group also showed significantly poorer survival probability than NHI group after PS matching (p=0.011). CONCLUSION: This study showed that 1-year mortality was higher in ICU survivors with low economic status, even if financial coverage was provided by the government. Our result suggests the necessity of a more nuanced and multifaceted approach to policy for ICU survivors with low economic status.
Subject(s)
Humans , Cohort Studies , Critical Care , Financing, Government , Insurance , Intensive Care Units , Korea , Mortality , National Health Programs , Propensity Score , Retrospective Studies , Survivors , Tertiary Care CentersABSTRACT
PURPOSE: The mortality of motorcycle accidents in old age is very high in Korea compared with other countries. The aim of this study is to compare the differences in injury patterns and severity between younger and older riders in motorcycle accidents. METHODS: Cross sectional data from Konkuk University Chung-ju Hospital were used to evaluate patients who visited the emergency department as a result of a motorcycle accident from June 2012 to May 2014. We separated the patients into younger rider group from 16 to 64 and older rider group over 65 years of age. Injury sustained, the types of severe injuries and injury severity between two groups were compared using Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). RESULTS: The younger and older rider group included 310 and 111 patients, respectively. Injuries in head, face, chest, and lumbar spine were higher in the older rider group (p<0.05). In the comparison of severe injury sustained over AIS 2, the older rider group had a four-fold odds increased rate of head injury (OR 3.718, 95% CI: 2.317-5.965, p<0.001) and a two-fold odds increased rate of chest injury (OR 2.306, 95% CI: 1.199-4.437, p=0.016) compared with the younger rider group. In addition, the older rider group had a nearly seven fold increased odds of severe injury over ISS 15 (OR 7.108, 95% CI: 3.579-14.119, p<0.001). CONCLUSION: In a motorcycle accident, the frequency of head, facial, chest, and lumbar injuries was higher in the older rider group. In addition, the older rider group had a higher injury severity, particularly a higher risk of head and chest injury.