探討社經地位對血管支架置入病患死亡風險之影響

Impact of socioeconomic status on mortality following stent implantation

目標：台灣全民健保大幅減少民眾就醫費用之負擔，改善民眾就醫可近性，在此情況下是否能消弭健康不平等？本研究針對接受治療冠心病的重要方法-血管支架置放術（stent implantation）之患者，探討社經地位是否會影響其死亡情形。方法：本研究採回溯性世代研究法，使用2008-2010年全國健保及相關次級資料，以2009年第一次接受血管支架置入之成年病患（19,113位）為研究對象，以邏輯斯迴歸探討血管支架置入病患之社經地位（教育程度與收入狀況）對其一年內死亡情形之影響，並控制病人特質、共病症指數及醫院特質。結果：2009年接受血管支架置入新個案之一年內心血管疾病死亡率為5.65%、全死因死亡率為11.93%。校正相關變項後發現，教育程度為小學以下者之心血管疾病死亡及全死因死亡風險分別為大專以上者之1.37倍（95% CI=1.06-1.77）及1.54倍（95% CI=1.28-1.85）；而低收入者之心血管疾病死亡及全死因死亡風險分別為高收入者之1.22倍（95% CI=1.02-1.46）及1.16倍（95% CI=1.02-1.32），教育程度之差距較收入差距大。結論：接受血管支架置入病患在死亡風險上存在社經差異，建議衛生主管單位可加強提升低社經族群的健康識能，以縮小不同社經地位之血管支架置入病患的健康差距。

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 mortality 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 the 1-year mortality rate by controlling the characteristics of patients and major health care organizations. Results: The 1-year mortality rate of patients who underwent stent implantation in 2009 was 11.93%. Patients with a primary school level of education had a 1.54-fold risk of death compared to patients with a university education after controlling for other factors (OR=1.54, 95% CI=1.28-1.85), and the risk of death in the low-income group was 1.16- fold that of the high-income group (OR=1.16, 95% CI=1.02-1.32). Conclusions: Disparities in mortality 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.