| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 103 === Objectives: The burden of medical expenditures has been reduced and the accessibility to health care has improved as a result of the implementation of the Taiwan National Health Insurance program. Nevertheless, does health inequality still exist? The objective of this study was to determine the association between the cross-level effects of individual socioeconomic status (SES) on stent selection and outcomes in patients who have undergone stent implantation in Taiwan.
Methods: This study involved a retrospective cohort. Adults from the 2008–2010 Taiwan National Health Insurance database who underwent stent implantation in 2009 and relative secondary data were examined. Logistic regression models were performed to determine the effect of SES (educational level and income status) on stent selection, the 1-year mortality rate and MACE by controlling the characteristics of patients and major health care organizations.
Results: There were total 19,113 patients underwent stent implantation in 2009 and 37.64% of which were with DES. The 1-year mortality and MACE rate of patients was 11.93% and 34.98% respectively. Patients with lower SES were much unlikely to undergo the treatment with DES (AOR=0.33, 95%CI=0.30-0.37) and had bad outcomes compared to patients with higher SES: the primary school level of education had a 1.54-fold risk of death and 1.12-fold risk of MACE compared to patients with a university education after controlling for other factors (AOR=1.54, 95% CI=1.28-1.85; AOR=1.12, 95%CI=1.00-1.26). Besides, the risk of death and MACE in the low-income group was 1.16-fold and 1.10-fold respectively than that of the high-income group (AOR=1.16, 95% CI=1.02-1.32; AOR=1.10, 95%CI=1.01-1.19). Conclusions: Disparities in stent selection and prognosis outcomes exist between different SES groups. If the government enhances healthy literacy in the low-SES group, the gap in health disparities for patients who undergo stent implantation might decline.
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