Affiliation:
1. Sichuan University National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, , No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province 610041, P.R. China
2. The Eighth People’s Hospital of Chengdu , No. 1120, Rongdu Avenue, Xindu District, Chengdu, Sichuan 610000, P.R. China
Abstract
Abstract
Since the public long-term care insurance (LTCI) system was piloted in Chengdu, China, in October 2017, there has been considerable growth of LTC institutions in China. This study aimed to evaluate the health value effect of LTCI in older patients with severe disabilities in an LTC institution. This prospective study was based on data from 985 severe disability patients with or without LTCI from October 2017 to May 2021 in the Eighth People’s Hospital, Chengdu, China. The Cox proportional hazard model estimated LTCI’s health value, including survival probability and risk of pneumonia/pressure ulcers. Subgroup analysis was performed for sex, age, Charlson Comorbidity Index (CCI), and the number of drugs. In the analysis, 519 and 466 patients in LTCI and non-LTCI groups were included, respectively. In adjusted Cox analyses, the LTCI group had a significantly elevated survival rate compared with the non-LTCI groups at 12 months (P < .001, hazard ratio (HR) = 1.758, 95% confidence interval (CI) 1.300–2.376). At 40 months, the adjusted survival rate was 62.6% in the LTCI group, which was significantly higher (53.7%; P = .003, HR = 1.438, 95% CI 1.131–1.831). The subgroups of patients aged 60 to 79 years (interaction P = .007) and with CCI ≥ 3 (interaction P = .026) were more significantly associated with survival improvement than those aged >80 years and with CCI< 3. The LTCI group was also at lower risk for hospital-acquired pneumonia (P = .016, HR 0.622, 95% CI 0.422–0.917) and pressure ulcers (P = .008, HR 0.695, 95% CI 0.376–0.862). The improved survival of LTCI remained stable in sensitivity analyses. For older patients with severe disabilities, in a LTC institution, LTCI significantly improved their health profile and longevity after a year, suggesting the large role and development potentiality of institution care in the LTCI system of China.
Funder
The National Key R&D Program of China
the Regional Innovation Cooperation Program of Science and Technology Commission Foundation of Sichuan Province
Publisher
Oxford University Press (OUP)
Subject
Public Health, Environmental and Occupational Health,Health Policy,General Medicine