Loco-regional Risk Factors for Acute Stroke Mortality in Korea Based on Claim Data of Health Insurance Review and Assessment Service

Abstract

We aim to elucidate the discrepancies in acute stroke mortality among primary local governments and identify the risk factors of the mortality at loco-regional level to establish tailored health policies in Korea. From January 1, 2017 to December 31, 2019, the mortality rates of patients who died from stroke within 30 days of hospitalization in 226 municipalities were analyzed using the claims data accumulated by Health Insurance Review and Assessment Service. Demographic factors (elderly population ratio, gender ratio, alcohol consumption rate, smoking rate, subjective health status awareness), socioeconomic factors (ratio of old houses, financial autonomy rate, rate of medical aid beneficiaries) and medical resource factors (number of hospitals/ doctors) were analyzed. Acute stroke mortality rate in Korea is 12.1 ± 2.2%. The region with the lowest mortality rate is Gyeonggi Province (local government mainly consisting of urban cities) and regions with the highest mortality rates are North Chungcheong Province and South Jeolla. The elderly population is associated with mortality using overall nationwide data. It was also risk factor for stroke mortality in the cities or counties in rural areas. The male-female ratio, alcohol consumption rate, financial autonomy rate, and number of hospitals in the region were also mortality risk factors based on the data of urban cities. Based on the results from counties, the proportion of elderly population and financial autonomy rate were found to be a significant risk factor for stroke mortality in small towns in rural areas. Regional differences of acute stroke mortality were also found. Aside from demographic factors (proportion of elderly population), socioeconomic factors (financial autonomy rate) were identified as risk factors for acute stroke mortality. Collectively, it is necessary to build health care policies that address the health inequality at the loco-regional level.