Background: The annual incidence of stroke in China has increased more drastically in women; moreover, women who experience stroke are less likely to recover. Despite a few studies that have demonstrated gender differences in stroke care and outcomes, there has been limited research exploring insurance-related disparities in outcomes, particularly among female stroke patients. We examined the relationship between rural/urban insurance status on the 1-year clinical outcomes of stroke in women.
Method: Cox proportional hazard model was employed to analysis the clinical outcome endpoints in our model. The logistic regression model was used to select significant risk factors. The generalized estimating equation model was applied to control the cluster effect of hospitals in order to obtain a more precise estimation.
Results: Compared with women covered by the Urban Resident/Employee Basic Medical Insurance (URBMI/UEBMI), those covered by the New Rural Cooperative Medical Scheme (NRCMS) were younger, less likely to have vascular risk factors and stroke awareness or undergone treatment for hypertension and dyslipidemia, and more likely to have received early antithrombotics, antithrombotics at discharge, and lipid-lowering drugs (Table 1). One-year stroke recurrence and mortality was significantly higher in women covered by the NRCMS (Table 2). Significant differences in age, stroke risk factors, awareness and treatment, care process, and 1-year stroke recurrence and mortality were observed.
Conclusion: Healthcare policymakers need to focus their attention on these disparities and take suitable steps to improve primary healthcare service in rural areas.