| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 101 === Background Since 2007, coronary artery disease (CAD) has risen to the second among the top ten leading causes of death. In addition, in 2011, 10.9% of the death people were attributed to heart diseases. Coronary artery bypass graft (CABG) is the main technique to cure cardiovascular disease,and post-operation death and rehospitalization are often used to evaluate the quality of care for patients. In Taiwan, the risks of post-operation death and rehospitalization are different from those in Europe and the U.S. Although the implementation of National Health Insurance has reduced the economic barrier to medical care in general, it is still needed to clarify whether the post-operation quality in CABG patients is influenced by the social-economic status of the patients and of the patients’ living area.
Objectives study aimed to discuss the influence of individual and neighborhood social-economic status on post-operation quality in CABG patients; moreover, the other risk factors will be discussed.
Methods A retrospective cohort study was conducted,and the new CABG adult patients who were operated in 2009 and 2010 were the study population. Using the data from county/city important statistical indexs published by the Directorate-General of Budget, Accounting and Statistics, Excutive Yuan, R.O.C. (Taiwan) and National Health Insurance Research Database in 2008 to 2011, the study variables were defined. Dependent variable were 1) death within 30 days after operation,and 2) rehospitalization within 30 days after discharge; independent variable were 1) individual social-economic status, and 2) neighborhood social-economic status. Binary logistic regression was used to analyse the influence of individual &; neighborhood social-economic status on post-operational quality in CABG patients.
Results The death rate within 30 days after operation of the new CABG adult patients in 2009 and 2010 was 4.78%. The rehospitalization rate within 30 days after discharge was 9.17%. The results reported that higher risk of post-operation death was associated with unemployed patients (OR=1.50, 95% CI=1.03-2.17) and patients who lived in area with a higher unemployment rate (OR=1.91, 95% CI=1.37-2.67). After patients were classified into different age groups, for the patients whose age was higher than 65 years old, the study found that unemployment (OR=1.86, 95% CI=1.12-3.10) and living in an area with higher umemployment rate (OR=2.03, 95% CI=1.33-3.08) were the factors related to higher risk of post-operation death. Also, for the patients whose age was between 18 and 64, higher risks of post-operation death were related to insurance registered area with higher umemployment rate(OR=1.78, 95% CI=1.02-3.09). On the other hand, the risk of rehospitalization after discharge was higher in patients who registered their insurance in the area with higher umemployment rates (OR = 1.25, 95% CI=1.00-1.57), and those who registered their insurance in the area with lower mean annual income (OR=1.19, 95% CI =1.01-1.58). However, individual social-economic status was not significantly related to rehospitalization after discharge. After patients were classified by different age groups, individual &; neighborhood social-economic status was also not significantly related to rehospitalization after discharge.
Conclusions Individual and neighborhood social-economic status were significantly related to the post-operation quality in the CABG patients. The results showed that even National Health Insurance had been implemented, some unequal phenomena still existed in the prognosis of CABG patients. It is suggested that health authorities should reinforce post-operation self-care ability and health literacy of the people with relatively weak social-economic. Morever, for the patients who live in higher risk areas, the government should put more man-powers and care. The medical suppliers should strengthen health education and trace the patients who are older than 65 years old and those who have much more severe comorbidities.
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