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Association of Health Insurance with Post-Resuscitation Care and Neurological Outcomes after Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients in the Republic of Korea.

Resuscitation 2019 January 10
BACKGROUND: We investigated the association of health insurance status with post-resuscitation care and neurological recovery in out-of-hospital cardiac arrest (OHCA) and whether the effects changed with age or gender.

METHODS: Adult OHCAs with presumed cardiac etiology who had sustained ROSC from 2013 to 2016 were enrolled from the nationwide OHCA registry of Korea. Insurance status was categorized into 2 groups: National Health Insurance (NHI) and Medical Aid (MA). The endpoints were post-resuscitation coronary reperfusion therapy (CRT), targeted temperature management (TTM), and good neurological recovery (cerebral performance category of 1 or 2). Multivariable logistic regression models and interaction analyses (insurance × age and insurance × gender) were conducted for adjusted odds ratios (aORs) and 95% confidence intervals (CI).

RESULTS: Of a total of 19,865 eligible OHCA patients, 18,119 (91.2%) were covered by NHI and 1,746(8.8%) by MA. The MA group was less likely to receive post-resuscitation CRT and TTM (aOR (95% CI): 0.75(0.59-0.96) for CRT; 0.71(0.57-0.89) for TTM) and had worse neurological outcomes (0.71(0.57-0.89)) compared with the NHI group. In the interaction analyses, MA was associated with less CRT and good neurological recovery in the 45-64 year old group (0.54(0.37-0.77) for CRT; 0.70(0.51-0.95) for neurological outcome) and in the male group (0.69(0.52-0.91) for CRT; 0.77(0.61-0.97) for TTM; 0.70(0.53-0.92)) for neurological outcome).

CONCLUSIONS: There were disparities in post-resuscitation care and substantial neurological recovery by health insurance status, and the disparities were prominent in middle-aged adults and males. Increasing health insurance coverage for post-resuscitation care should be considered.

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