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. 2020 Feb 11;20(1):212.
doi: 10.1186/s12889-020-8335-3.

Urban-rural disparity in lower extremities amputation in patients with diabetes after nearly two decades of universal health Insurance in Taiwan

Chung-Hao Li  1   2 , Chia-Chun Li  3 , Chin-Li Lu  3   4 , Jin-Shang Wu  2   5 , Li-Jung Elizabeth Ku  6 , Chung-Yi Li  3   7   8
Affiliations

Urban-rural disparity in lower extremities amputation in patients with diabetes after nearly two decades of universal health Insurance in Taiwan

Chung-Hao Li et al. BMC Public Health. .

Abstract

Background: To assess the prevalence of urban-rural disparity in lower extremities amputation (LEA) among patients with diabetes and to explore whether patient-related or physician-related factors might have contributed to such disparity.

Methods: This was a population-based study including patients with diabetes aged ≥55 years from 2009 to 2013. Among them, 9236 received LEA. Data were retrieved from Taiwan's National Health Insurance (NHI) claims. A multiple Poisson regression model was also employed to assess the urban-rural difference in LEA prevalence by simultaneously taking into account socio-demographic variables and density of practicing physicians.

Results: Between 2009 and 2013, the annual prevalence of LEA declined from 30.4 to 20.5 per 10,000 patients. Compared to patients from urban areas, those who lived in sub-urban and rural areas suffered from a significantly elevated prevalence of LEA, with a prevalence rate ratio (PRR) of 1.47 (95% CI, 1.39-1.55) and 1.68 (95% CI, 1.56-1.82), respectively. The density of physicians who presumably provided diabetes care can barely explain the urban-rural disparity in LEA prevalence.

Conclusions: Although the universal health insurance has largely removed financial barriers to health care, the urban-rural disparity in LEA prevalence still exists in Taiwan after nearly two decades of the NHI program.

Keywords: Amputation; Diabetes; Disparity; Lower extremity; National Health Insurance; Urbanization.

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Conflict of interest statement

The authors declare that they have no competing interests.

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