Inequality in Health: Correlation Between Poverty and Injury – A Comprehensive Analysis Based on Income Level in Taiwan: A Cross-sectional Study
Abstract Background For better health promotion in Taiwan, it needs an action to reduce health inequality; therefore a comprehensive monitoring on social determinants and health is urgent. Is income the obstacle to influence the health after Taiwan instituted national health insurance in 1995? We compared the characteristics of accident injuries for patients classified with low-income and non-low-income who required inpatient care. Methods We collected accident injury inpatient cases from 1998 to 2015 from the Health and Welfare Data Science Center, Ministry of Health and Welfare and categorized the patients as low-income and non-low-income. Chi-square tests, Fisher exact tests, an independent samples t-test, and percentages were used to identify differences in demographics, cause for hospitalization, and other hospital care variables. Results Between 1998 and 2015, there were 74,337 low-income accident injury inpatients, which represented 1.6% of all injury event inpatients. The hospitalization mortality rate for the low-income group was 1.9 times higher than that of the non-low-income group. Further, the average length of hospital stay (9.9 days), average medical expenses (1,681 USD), and mortality rate (3.6%) for the low-income inpatients were higher than those of the non-low-income group (7.6 days, 1,573 USD, and 2.1%, respectively). Among the common injury causes, the percentage of injuries from “medical malpractice,” “fall,” “suicide,” and “homicide” were higher for the low-income group than that for the non-low-income group. Conclusions Despite National Health Insurance coverage, we found a higher hospitalization rate, longer average length of hospital stay, and a higher mortality rate in the low-income group. These findings support our hypothesis that there is a correlation between health and income level, resulting in health inequality. Achieving health care equality may require collaboration between the government and private and nonprofit organizations to increase awareness of this phenomenon.