Associations of Individual Income and Early Rehabilitation with Outcomes for Patients with Ischemic Stroke

Background：Cerebrovascular disease is the third most common cause of death in Taiwan. Personal income and early rehabilitation may be related to the stroke care outcome. Objectives：The objective of this study was to understand the relationship between individual income, early rehabilitation and outcomes after stroke. Method：This study analyzed samples of 1 million beneficiaries of the Longitudinal Health Insurance Database, a data subset of the National Health Insurance Research Database, to investigate discharged patients that experienced an acute ischemic stroke in 2009–2011. The variables affecting the stroke care outcomes included the risks of readmission within 1 year and death within 1 year. Through the Cox proportional hazards model, the correlations among personal income, early rehabilitation, and treatment outcome were determined. The control variables were the patient and local characteristics. Result：The patients with high personal income exhibited low risks of readmission or death within 1 year. The patients receiving early rehabilitation exhibited low risks of death within 1 year. Moreover, the patients receiving outpatient rehabilitation exhibited lower risks of readmission and death within 1 year than did those receiving inpatient rehabilitation, and the patients receiving rehabilitation in primary care clinics demonstrated higher risks of readmission within 1 year than did those receiving rehabilitation in hospitals. Conclusion： The patients with low personal income and without receiving early rehabilitation have poor outcomes after stroke. Moreover, the patients receiving outpatient rehabilitation are better than receiving inpatient rehabilitation, and the patients receiving rehabilitation in hospitals demonstrated lower risks of readmission within 1 year than did those receiving rehabilitation in primary care clinics.