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.
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 1746 (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.
['Kim|Tae Han|TH|', 'Ro|Young Sun|YS|', 'Shin|Sang Do|SD|', 'Song|Kyoung Jun|KJ|', 'Hong|Ki Jeong|KJ|', 'Park|Jeong Ho|JH|', 'Kong|So Yeon|SY|']
D000328:Adult D000359:Aftercare D000368:Aged D016887:Cardiopulmonary Resuscitation D004636:Emergency Service, Hospital D005260:Female D006801:Humans D007036:Hypothermia, Induced D007348:Insurance, Health D008297:Male D008875:Middle Aged D015425:Myocardial Reperfusion D020380:Needs Assessment D009422:Nervous System Diseases D058687:Out-of-Hospital Cardiac Arrest D010351:Patient Discharge D020127:Recovery of Function D056910:Republic of Korea
Health insurance Post-resuscitation care Out-of-hospital cardiac arrest