{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T11:36:08Z","timestamp":1773920168316,"version":"3.50.1"},"reference-count":39,"publisher":"BMJ","issue":"7","funder":[{"name":"Beijing Municipal Committee of Science and Technology"},{"name":"Supported by grants from the Ministry of Science and Technology of the People\u2019s Republic of China"},{"DOI":"10.13039\/501100011709","name":"Beijing Institute for Brain Disorders","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100011709","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Beijing Tiantan Hospital Seeding Initiative"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,6,1]]},"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Although more than 95% of the population is insured by urban or rural insurance programmes in China, little research has been done on insurance-related outcome disparities for patients with acute stroke and transient ischaemic attack (TIA). This study aimed to examine the relationship between insurance status and 1-year outcomes for patients with stroke and TIA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We abstracted 24\u2009941 patients with acute stroke and TIA from the China National Stroke Registry II. Insurance status was categorised as Urban Basic Medical Insurance Scheme (UBMIS), New Rural Cooperative Medical Scheme (NRCMS) and self-payment. The relationship between insurance status and 1-year outcomes, including all-cause death, stroke recurrence and disability, was analysed using the shared frailty model in the Cox model or generalised estimating equation with consideration of the hospital\u2019s cluster effect.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>About 50% of patients were covered by UBMIS, 41.2% by NRCMS and 8.9% by self-payment. Compared with patients covered by UBMIS, patients covered by NRCMS had a significantly higher risk of all-cause death (9.7% vs 8.6%, adjusted HR: 1.32 (95% CI 1.17 to 1.48), p&lt;0.001), stroke recurrence (7.2% vs 6.5%, adjusted HR: 1.12 (95% CI 1.11 to 1.37), p&lt;0.001) and disability (32.0% vs 26.3%, adjusted OR: 1.29 (95% CI 1.21 to 1.39), p&lt;0.001). Compared with patients covered by UBMIS, self-payment patients had a similar risk of death and stroke recurrence but a higher risk of disability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Patients with stroke and TIA demonstrated differences in 1-year mortality, stroke recurrence and disability between urban and rural insurance groups in China.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-021334","type":"journal-article","created":{"date-parts":[[2018,8,1]],"date-time":"2018-08-01T11:16:25Z","timestamp":1533122185000},"page":"e021334","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Insurance status and 1-year outcomes of stroke and transient ischaemic attack: a registry-based cohort study in China"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1608-1856","authenticated-orcid":false,"given":"Hong-Qiu","family":"Gu","sequence":"first","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing, China"},{"name":"Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zi-Xiao","family":"Li","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing, China"},{"name":"Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xing-Quan","family":"Zhao","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing, China"},{"name":"Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Ping","family":"Liu","sequence":"additional","affiliation":[{"name":"Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"},{"name":"Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Li","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing, China"},{"name":"Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Juan","family":"Wang","sequence":"additional","affiliation":[{"name":"Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"},{"name":"Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Yang","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing, China"},{"name":"Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhen-Zhen","family":"Rao","sequence":"additional","affiliation":[{"name":"Institute of Molecular Medicine, Yingjie Center, Peking University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Xue","family":"Wang","sequence":"additional","affiliation":[{"name":"Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"},{"name":"Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3082-6789","authenticated-orcid":false,"given":"Yue-Song","family":"Pan","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing, China"},{"name":"Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Long","family":"Wang","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing, China"},{"name":"Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong-Jun","family":"Wang","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing, China"},{"name":"Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"},{"name":"Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,8,1]]},"reference":[{"key":"2025101812131754000_8.7.e021334.1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.publhealth.28.021406.144042"},{"key":"2025101812131754000_8.7.e021334.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2006.00513.x"},{"key":"2025101812131754000_8.7.e021334.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2005.00491.x"},{"key":"2025101812131754000_8.7.e021334.4","doi-asserted-by":"crossref","first-page":"167","DOI":"10.2147\/CLEP.S106258","article-title":"Chinese health care system and clinical epidemiology","volume":"9","author":"Sun","year":"2017","journal-title":"Clin Epidemiol"},{"key":"2025101812131754000_8.7.e021334.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1410425"},{"key":"2025101812131754000_8.7.e021334.6","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318185c913"},{"key":"2025101812131754000_8.7.e021334.7","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.05.007","article-title":"Association of Insurance Status with Stroke-Related Mortality and Long-term Survival after Stroke","volume":"24","author":"McManus","year":"2015","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2025101812131754000_8.7.e021334.8","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1997.00440280076006"},{"key":"2025101812131754000_8.7.e021334.9","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000257312.12989.af"},{"key":"2025101812131754000_8.7.e021334.10","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1186\/s12889-016-3627-3","article-title":"The relation between health insurance and management of hypertension in Shanghai, China: a cross-sectional study","volume":"16","author":"Zhang","year":"2016","journal-title":"BMC Public Health"},{"key":"2025101812131754000_8.7.e021334.11","doi-asserted-by":"crossref","first-page":"905","DOI":"10.7150\/ijms.8877","article-title":"The basic social medical insurance is associated with clinical outcomes in the patients with ST-elevation myocardial infarction: a retrospective study from Shanghai, China","volume":"11","author":"Liu","year":"2014","journal-title":"Int J Med Sci"},{"key":"2025101812131754000_8.7.e021334.12","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.004445"},{"key":"2025101812131754000_8.7.e021334.13","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-8-170"},{"key":"2025101812131754000_8.7.e021334.14","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.494336"},{"key":"2025101812131754000_8.7.e021334.15","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70023-7"},{"key":"2025101812131754000_8.7.e021334.16","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70031-5"},{"key":"2025101812131754000_8.7.e021334.17","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.025250"},{"key":"2025101812131754000_8.7.e021334.18","unstructured":"The Ministry of Health of the People\u2019s Republic of China. 2010 Annual chinese healthcare statistics. Beijing: China Union Medical University Publication, 2010."},{"key":"2025101812131754000_8.7.e021334.19","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.011833"},{"key":"2025101812131754000_8.7.e021334.20","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.014143"},{"key":"2025101812131754000_8.7.e021334.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2011.00584.x"},{"key":"2025101812131754000_8.7.e021334.22","doi-asserted-by":"publisher","DOI":"10.1177\/003693305700200504"},{"key":"2025101812131754000_8.7.e021334.23","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.25.11.2220"},{"key":"2025101812131754000_8.7.e021334.24","doi-asserted-by":"crossref","unstructured":"Wienke A . Frailty models in survival analysis: CRC Press, 2010.","DOI":"10.1201\/9781420073911"},{"key":"2025101812131754000_8.7.e021334.25","doi-asserted-by":"publisher","DOI":"10.2307\/2670170"},{"key":"2025101812131754000_8.7.e021334.26","doi-asserted-by":"crossref","unstructured":"Hardin JW . Generalized estimating equations (GEE): Wiley Online Library, 2005.","DOI":"10.1002\/0470013192.bsa250"},{"key":"2025101812131754000_8.7.e021334.27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00342-6"},{"key":"2025101812131754000_8.7.e021334.28","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.08.027","article-title":"Disparities in acute stroke severity, outcomes, and care relative to health insurance status","volume":"23","author":"Gezmu","year":"2014","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2025101812131754000_8.7.e021334.29","doi-asserted-by":"crossref","first-page":"870","DOI":"10.3171\/2014.12.JNS14646","article-title":"Health disparities and stroke: the influence of insurance status on the prevalence of patient safety indicators and hospital-acquired conditions","volume":"122","author":"Fargen","year":"2015","journal-title":"J Neurosurg"},{"key":"2025101812131754000_8.7.e021334.30","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.687"},{"key":"2025101812131754000_8.7.e021334.31","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.02.016","article-title":"Insurance status and outcome after intracerebral hemorrhage: findings from Get With The Guidelines-stroke","volume":"23","author":"James","year":"2014","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2025101812131754000_8.7.e021334.32","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.111.000034"},{"key":"2025101812131754000_8.7.e021334.33","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.639732"},{"key":"2025101812131754000_8.7.e021334.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2008.07.002"},{"key":"2025101812131754000_8.7.e021334.35","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03510060083037"},{"key":"2025101812131754000_8.7.e021334.36","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182563bf5"},{"key":"2025101812131754000_8.7.e021334.37","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/1478-4505-11-36","article-title":"Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress","volume":"11","author":"McIntyre","year":"2013","journal-title":"Health Res Policy Syst"},{"key":"2025101812131754000_8.7.e021334.38","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.08.053413"},{"key":"2025101812131754000_8.7.e021334.39","unstructured":"The State Council of the People\u2019s Republic of China. http:\/\/www.gov.cn\/xinwen\/2017-12\/14\/content_5246738.htm"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-021334","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T19:13:24Z","timestamp":1760814804000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-021334"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7]]},"references-count":39,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,8,1]]},"published-print":{"date-parts":[[2018,7]]}},"alternative-id":["10.1136\/bmjopen-2017-021334"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-021334","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7]]}}}