Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database

Abstract

​ObjectivesTo assess the impact of lower socioeconomic status on the outcome of major torso trauma patients under the single-payer system by the National Health Insurance (NHI) in Taiwan.​DesignA nationwide, retrospective cohort study.​SettingAn observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI.​ParticipantsPatients with major torso trauma (injury severity score ≥16) from 2003 to 2013 in Taiwan were included. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify trauma patients. A total of 64 721 patients were initially identified in the NHIRD. After applying the exclusion criteria, 20 009 patients were included in our statistical analysis.​Primary and secondary outcome measuresThe primary outcome measure was in-hospital mortality, and we analysed patients with different income levels and geographic regions. Multiple logistic regression was used to control for confounding variables.​ResultsIn univariate analysis, geographic disparities and low-income level were both risk factors for in-hospital mortality for patients with major torso trauma (p=0.002 and <0.001, respectively). However, in multivariate analysis, only a low-income level remained an independent risk factor for increased in-hospital mortality (p<0.001).​ConclusionEven with the NHI, wealth inequity still led to different outcomes for major torso trauma in Taiwan. Health policies must focus on this vulnerable group to eliminate inequality in trauma care.

RETRACTED ARTICLE: The role of acute care surgeons in treating rib fractures—a retrospective cohort study from a single level I trauma center

“…Trauma surgeons frequently encounter chest trauma. Approximately 40% of patients with an injury severity score (ISS) greater than 16 had concomitant thoracic injuries in Taiwan [ 1 ], and these injuries are accountable for up to 25% of trauma deaths [ 2 ]. Rib fractures are the most common thoracic injury in patients who sustained blunt trauma, and associated injuries with potential life-threatening outcomes often occur in these patients [ 3 ].…”

Authors’ Reply: Unstable Hemodynamics is not Always Predictive of Failed Nonoperative Management in Blunt Splenic Injury

“…Indeed, there were a few patients with an AIS equal or larger than 3 in extremities, which explains the presence of AIS and ISS in this study group. Previous studies have shown that the survival of such patients was less influenced by injuries to the extremities, but mostly by injuries to the torso region [1, 2]. The imprecise terminology does not bias the conclusion of this study.…”