Urban-rural disparity in lower extremities amputation in patients with diabetes after nearly two decades of universal health Insurance in Taiwan

Abstract

Background: To assess the prevalence of urban-rural disparity in lower extremities amputation (LEA) among patients with diabetes and to explore whether patient-related or physician-related factors might have contributed to such disparity.Methods: This was a population-based study including patients with diabetes aged ≥55 years from 2009 to 2013. Among them, 9236 received LEA. Data were retrieved from Taiwan's National Health Insurance (NHI) claims. A multiple Poisson regression model was also employed to assess the urban-rural difference in LEA prevalence by simultaneously taking into account socio-demographic variables and density of practicing physicians. Results: Between 2009 and 2013, the annual prevalence of LEA declined from 30.4 to 20.5 per 10,000 patients. Compared to patients from urban areas, those who lived in sub-urban and rural areas suffered from a significantly elevated prevalence of LEA, with a prevalence rate ratio (PRR) of 1.47 (95% CI, 1.39-1.55) and 1.68 (95% CI, 1.56-1.82), respectively. The density of physicians who presumably provided diabetes care can barely explain the urbanrural disparity in LEA prevalence. Conclusions:Although the universal health insurance has largely removed financial barriers to health care, the urban-rural disparity in LEA prevalence still exists in Taiwan after nearly two decades of the NHI program.

Analysis of the Effectiveness of Transradial Access Puncture in the Application of Complications and Comfort after Cerebral Angiography

“…The radial artery is relatively shallowly located, and the percutaneous radial artery vascular access test was first applied to coronary angiography in 1989 and first applied to interventional treatment in 1993 [ 8 ]. After years of practice, improvement, and refinement, transradial artery puncture has been gradually applied to cerebrovascular interventions [ 9 ]. The study [ 10 ] reported that the success rate of neurointerventional procedures with transradial access reached 94.5%, and the complication rate was also lower compared with transfemoral access puncture, which was only 2.9%.…”

Incidence of Idiopathic Cardiomyopathy in Type 2 Diabetes Patients: Age, Sex, and Urbanization status stratified Analysis

“…Rural patients in Taiwan were older and had more chronic diseases than urban and suburban counterparts [25], but rural diabetes patients were less likely to receive guideline-recommended examinations or tests [26]. Although the universal health insurance has largely removed financial barriers to health care, the urban-rural disparity in prevalence of diabetic complications still exists after nearly two decades of implementation of the NHI program in Taiwan [27]. Further studies are necessary to detect the definite underlying etiologies and measures to eliminate such urban-rural difference in various diabetic complications, including idiopathic cardiomyopathy.…”

Incidence of Idiopathic Cardiomyopathy in Patients with Type 2 Diabetes in Taiwan: Age, Sex, and Urbanization Status-stratified Analysis

“…Patients from rural areas in Taiwan are older and have more chronic diseases than their urban and suburban counterparts [36], but patients with diabetes who live in rural areas are less likely to receive guideline-recommended examinations or tests [37]. Although the universal health insurance has largely removed nancial barriers to health care, the urban-rural disparity in prevalence of diabetic complications still exists after nearly two decades of implementation of the NHI program in Taiwan [38]. Further studies are necessary to detect the de nite underlying etiologies and measures to eliminate such urban-rural difference in various diabetic complications, including idiopathic cardiomyopathy.…”