Exploring the relationship between urban-rural health disparities and post-acute rehabilitation care on ischemic stroke patients and mortality in Taiwan

Background. Health disparity is one of the key research issues around the world. Because of the uneven distributions of medical resources in Taiwan, the issue of health disparity is derived. In recent years, stroke is the third leading place in Taiwan and it may leave varying degrees of permanent disability. Therefore, they may require continuity of care after acute inpatient discharge. However, the relationship between Post-Acute Care (PAC) and the death of stroke patients is still not clear. Objective. The aim of this study was to explore the association between urban-rural health disparities and post-acute rehabilitation care on ischemic stroke patients and 1 year mortality. Methods. This study used data from the nationwide representative sample through the National Health Insurance Research Database between 2011 and 2012. Patients who underwent first time admission in 2011 with a principal ICD-9-CM diagnosis codes 433, 434 and 436 were identified in this study. Cox proportional hazards model was conducted to examine the association between urban-rural health disparities and post-acute rehabilitation care on ischemic stroke patients and 1 year mortality. Results. There were 1456 patients included in this study. The study showed that compared with patients living in rural areas, patients living in urban tended to survive longer in a year. Moreover, as the frequency of rehabilitation increased, patients tended to survive longer in a year. Conclusion. Compared with patients living in rural areas, patients living in urban tended to survive longer in a year. Therefore, the importance of resource distribution and accessibility of medical care should be noticed. Meanwhile, patients should rehabilitate within 3 months after discharging from hospitals, and increased the frequency of rehabilitation.