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

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.