Online Program

Health inequality of risk of fall-related events in the elderly in Taiwan-does national health insurance help?

Tuesday, November 5, 2013

Yih-Jian Tsai, MD, MSc, Adult and Elderly Health Division, Bureau of Health Promotion, Department of Health, Taiwan, Taichung, Taiwan
Che-Wei Shu, Population and Health Research Center, Bureau of Health Promotion, Department of Health, Taiwan, Taichung, Taiwan
Baai-Shyun Hurng, PhD, Department of Health, Health Promotion Administration, Ministry of Health and Welfare, Taichung City, Taiwan
Objective: Given socioeconomic status is a key determinant of health (Marmot, Wilkinson, 1999), few studies address the possible socioeconomic gradient of fall-related events in the elderly in Taiwan. Methods: The 2007 Taiwan Longitudinal Study on Ageing (TLSA) data was used to examine the association of fall-related events (falls, fall injury and subsequent Western medical care utilization) with socioeconomic status. Socioeconomic status (SES) was measured with education level, annual household income, and residence area(rural, urban). The association was examined with bivariate analysis (using chi square test). Multi-variate logistic regression models were constructed to further investigate the association after firstly adjusted for age and sex, and then additionally controlled for intrinsic risk factors. Results: Among 2,700 elders, there were 655 fallers (22.7%), and 211 injured fallers (7.2%), of whom 189 persons sought Western medical care. Falls had a statistically significant association with educational level, but not for annual household income and residence area. The relative risk of falls decreased by educational level even adjusted for age and sex in multi-variate logistic regression models. However, the association became non-significant in a full-adjusted model. The relative risk of injurious falls tended to be higher among older adults living in urban areas than in rural areas. No statistically significant association was found between SES and subsequent Western medical care utilization. Conclusion: The launching of the National Health Insurance Program in 1995 exempted the injured fallers from economic barrier of Western medical care utilization, in spite of a socioeconomic gradient of falls and injurious falls risk.

Learning Areas:

Chronic disease management and prevention
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Identify a socio-economic gradient of risk of fall-related events. Demonstrate universal coverage of medical care in the NHI for the elderly exempted them from economic barrier of medical care utilization after a fall injury. Imply further study should be focused on the trajectory of the transition of risk of fall-related events accompanying SES changes, and therein lies our possible planning for intervention.

Keyword(s): Elderly, Health Risks

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been in charge of fall prevention policy drafting, and working on the title submitted in terms of study design, data analysis, interpretation of results, and drawing a conclusion from the beginning to the end.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.