The Korean Journal of Emergency Medical Services (한국응급구조학회지)

The Korea Society of Emergency Medical Services (한국응급구조학회)
권호 표지
DOI QR코드

DOI QR Code

Comparing the outcomes of out-of-hospital cardiac arrest between national health insurance and medical aid in Seoul before and during COVID-19 pandemic

코로나 전후 보험유형에 따른 서울 지역 병원밖 급성심정지 환자의 결과 비교

  • Kyoung-Youl Lee (Department of Emergency Medical Service, Kongju National University)
  • 이경열 (국립공주대학교 응급구조학과, 국립공주대학교 재난안전교육연구센터)
  • Received : 2023.11.05
  • Accepted : 2023.12.20
  • Published : 2023.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The objective of this study was to compare the outcome of out-of-hospital cardiac arrest (OHCA) between National Health Insurance(NHI) and Medical Aid(MA), before (2019) and during 2020 COVID-19 in Seoul. Methods: This is a retrospective cohort study that used nationwide OHCA registry collected in 2019 and 2020. The participants were patients with medical etiology who lived in Seoul and were transferred by 119 ambulance in Seoul. It was classified into NHI and MA according to health insurance status. Main outcomes included survival rate and good neurological recovery. Results: A total of 2,888 patients (2,543 NHI and 345 MA) in 2019 and 2,949 patients (2,638 NHI and 311 MA) in 2020 were included. In 2020, the bystander cardiopulmonary resuscitation (CPR), was significantly lower in MA (25.7%) than in NHI (38.1%). Survival rate in the MA decreased from 11.6% in 2019 to 10.6% in 2020, while increased from 10.1% to 13.3% in NHI. The odds ratio of good neurological recovery were 0.47 (95%CI, 0.25-0.86) for the MA group compared with NHI during 2020 COVID-19. Conclusion: There were disparities in bystander CPR and good neurological recovery by health insurance status during COVID-19 pandemic. Public health interventions should strive to reduce disparity of MA group in OHCA.

Keywords

Acknowledgement

본 연구는 공주대학교 연구년 사업에 의하여 연구되었음

References

  1. Korea Disease Control and Prevention Agency. 2021 Sudden cardiac arrest registry statistical report. 2022.
  2. Lee SY, Song KJ, Shin SD, Ro YS, Hong KJ, Kim YT et al. A disparity in outcomes of out-of-hospital cardiac arrest by community socioeconomic status: A ten-year observational study, Resuscitation 2018;126:130-6. https://doi.org/10.1016/j.resuscitation.2018.02.025
  3. Dahan B, Jabre P, Karam N, Misslin R, Tafflet M, Bougouin W et al. Impact of neighbourhood socioeconomic status on bystander cardiopulmonary resuscitation in paris. Resuscitation 2017;110:107-13. https://doi.org/10.1016/j.resuscitation.2016.10.028
  4. Chamberlain RC, Barnetson C, Clegg GR, Halbesma N. Association of measures of socioeconomic position with survival following out-of-hospital cardiac arrest: a systematic review. Resuscitation 2020;157:49-59. https://doi.org/10.1016/j.resuscitation.2020.09.025
  5. Sasson C, Magid DJ, Chan P, Root ED, McNally BF, Kellermann AL et al. CARES Surveillance Group. Association of neighborhood characteristics with bystander-initiated CPR. N Engl J Med 2012;367(17):1607-15. https://doi.org/10.1056/NEJMoa1110700
  6. Koo SJ, Ahn JH. Factors affecting out-of-hospital cardiogenic cardiac arrest mortality between patients with National Health Insurance and Medical Aid. The Korean Journal of Health Economics and Policy 2019;25(3):55-70.
  7. Lee JM, Lim Y, Cho YM, Lee TJ. Changes in horizontal equity of healthcare utilization before and after the Covid-19. The Korean Journal of Health Economics and Policy 2023;29(1):51-75.
  8. Hong J, Kim G. Difference in health-related quality of life between medical aid beneficiaries and health insurance beneficiaries using the community health survey. The Journal of the Korea Contents Association 2016;16:477-87. http://dx.doi.org/10.5392/JKCA.2016.16.05.477
  9. Park IK, Oh HK, Park SH, Park JM. Short term outcomes of gastric cancer surgery in public hospital. Korean J Clin Oncol 2012;8(2):16-22. https://doi.org/10.14216/kjco.12012
  10. Choi C, Lee S. An analysis of COVID-19's impact on the deaths of year 2020. Journal of the Korean Data & Information Science Society 2022;33(3):439-78. https://doi.org/10.7465/jkdi.2022.33.3.439
  11. Kim TH, Ro YS, Shin SD, Song KJ, Hong KJ, Park JH et al. Association of health insurance with post-resuscitation care and neurological outcomes after return of spontaneous circulation in out-of-hospital cardiac arrest patients in Korea. Resuscitation 2019;135:176-82. https://doi.org/10.1016/j.resuscitation.2018.12.023
  12. Alter DA, Naylor CD, Austin P, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. New England Journal of Medicine 1999;341(18):1359-67. https://doi.org/10.1056/NEJM199910283411806
  13. Haider AH, Chang DC, Efron DT, Haut ER, Crandall M, Cornwell EE. Race and insurance status as risk factors for trauma mortality. Archives of Surgery 2008;143(10):945-9. https://doi.org/10.1001/archsurg.143.10.945
  14. Choi DH, Ro YS, Park JH, Lee SY, Hong KJ, Song KJ et al. Evaluation of socioeconomic position and survival after out-of-hospital cardiac arrest in Korea using structural equation modeling. JAMA Network Open 2023;6(5):e2312722. https://doi.org/10.1001/jamanetworkopen.2023.12722