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

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 experi...

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Published inScientific reports Vol. 12; no. 1; p. 4327
Main Authors Park, Dougho, Lee, Su Yun, Jeong, Eunhwan, Hong, Daeyoung, Kim, Mun-Chul, Choi, Jun Hwa, Shin, Eun Kyong, Son, Kang Ju, Kim, Hyoung Seop
Format Journal Article
LanguageEnglish
Published England Nature Publishing Group 14.03.2022
Nature Publishing Group UK
Nature Portfolio
Subjects
Geography
Humans
Mortality
Patients
Republic of Korea - epidemiology
Retrospective Studies
Risk Factors
Social Class
Socioeconomic Factors
Socioeconomics
Stroke
Stroke - epidemiology
Survival
Republic of Korea
South Korea
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Summary: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.
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ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-022-08025-2