Association Between Health Insurance Type and Survival Outcomes: Insight Into the Impact of Socioeconomic Disparities in the Postoperative Outcomes of Abdominal Aortic Aneurysm in Korea

Abdominal aortic aneurysm (AAA) is associated with a high mortality rate if left untreated, and medically vulnerable populations experience significant disparities in treatment and outcomes. We investigated the characteristics and treatment outcomes of AAA according to the insurance type (i.e., Nati...

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Veröffentlicht in:	Journal of Korean medical science Jg. 40; H. 45; S. e238 - 19
Hauptverfasser:	Choi, Hong-Jae, Lim, Joon Seo, Jang, Won Mo, Oh, Se Jin
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Korea (South) 대한의학회 24.11.2025
Schlagworte:	Aged Aged, 80 and over Aortic Aneurysm, Abdominal - mortality Aortic Aneurysm, Abdominal - pathology Aortic Aneurysm, Abdominal - surgery Databases, Factual Endovascular Procedures Female Healthcare Disparities Humans Insurance, Health Kaplan-Meier Estimate Male Middle Aged National Health Programs Propensity Score Proportional Hazards Models Republic of Korea - epidemiology Risk Factors Socioeconomic Disparities in Health Socioeconomic Factors Treatment Outcome 의학일반 Republic of Korea Abdominal Aortic Aneurysms Healthcare Disparities Endovascular Aneurysm Repair Open Aneurysm Repair Mortality Health Insurance
ISSN:	1011-8934, 1598-6357, 1598-6357
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Abstract	Abdominal aortic aneurysm (AAA) is associated with a high mortality rate if left untreated, and medically vulnerable populations experience significant disparities in treatment and outcomes. We investigated the characteristics and treatment outcomes of AAA according to the insurance type (i.e., National Health Insurance [NHI] and Medical Aid) in South Korea using the nationwide health insurance database. From 2002 to 2019, a total of 15,065 patients underwent either open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR). The primary outcome was AAA-related mortality, with follow-up conducted until death or December 31, 2019, for those without mortality records. Mortality was evaluated using Kaplan-Meier curves and an adjusted Cox proportional hazards model to identify independent risk factors for AAA-related mortality. Propensity score matching (PSM) was employed using relevant covariates to achieve a 1:10 match between the NHI and Medical Aid groups. Among the EVAR patients, the rate of AAA-related mortality was significantly higher in the Medical Aid group compared to the NHI group ( < 0.001). After adjusting for covariates, the difference in AAA-related mortality rates between the two insurance groups remained statistically significant. No significant difference was found between the two groups among OAR patients ( = 0.727). Factors such as age, insurance type, hypertension, diastolic blood pressure, hemoglobin levels, and glomerular filtration rate were significantly associated with AAA-related mortality in the unadjusted multivariable analysis among the EVAR patients. Specifically, Medical Aid patients had a 1.87-fold higher risk of AAA-related mortality compared to NHI patients. Notably, in the PSM cohort, multivariable analysis confirmed that insurance type remained a significant factor for AAA-related mortality in EVAR patients. In patients undergoing EVAR for AAA, insurance type was independently associated with postoperative AAA-related mortality, with Medical Aid patients experiencing worse outcomes. In contrast, no significant difference in AAA-related mortality was observed between insurance types among patients undergoing OAR. These findings highlight the need to improve postoperative care and address outcome disparities in vulnerable populations undergoing EVAR.
AbstractList	Background: Abdominal aortic aneurysm (AAA) is associated with a high mortality rate if left untreated, and medically vulnerable populations experience significant disparities in treatment and outcomes. We investigated the characteristics and treatment outcomes of AAA according to the insurance type (i.e., National Health Insurance [NHI] and Medical Aid) in South Korea using the nationwide health insurance database. Methods: From 2002 to 2019, a total of 15,065 patients underwent either open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR). The primary outcome was AAA-related mortality, with follow-up conducted until death or December 31, 2019, for those without mortality records. Mortality was evaluated using Kaplan-Meier curves and an adjusted Cox proportional hazards model to identify independent risk factors for AAA-related mortality. Propensity score matching (PSM) was employed using relevant covariates to achieve a 1:10 match between the NHI and Medical Aid groups. Results: Among the EVAR patients, the rate of AAA-related mortality was significantly higher in the Medical Aid group compared to the NHI group (P < 0.001). After adjusting for covariates, the difference in AAA-related mortality rates between the two insurance groups remained statistically significant. No significant difference was found between the two groups among OAR patients (P = 0.727). Factors such as age, insurance type, hypertension, diastolic blood pressure, hemoglobin levels, and glomerular filtration rate were significantly associated with AAA-related mortality in the unadjusted multivariable analysis among the EVAR patients. Specifically, Medical Aid patients had a 1.87-fold higher risk of AAA-related mortality compared to NHI patients. Notably, in the PSM cohort, multivariable analysis confirmed that insurance type remained a significant factor for AAA-related mortality in EVAR patients. Conclusion: In patients undergoing EVAR for AAA, insurance type was independently associated with postoperative AAA-related mortality, with Medical Aid patients experiencing worse outcomes. In contrast, no significant difference in AAA-related mortality was observed between insurance types among patients undergoing OAR. These findings highlight the need to improve postoperative care and address outcome disparities in vulnerable populations undergoing EVAR. KCI Citation Count: 0 Abdominal aortic aneurysm (AAA) is associated with a high mortality rate if left untreated, and medically vulnerable populations experience significant disparities in treatment and outcomes. We investigated the characteristics and treatment outcomes of AAA according to the insurance type (i.e., National Health Insurance [NHI] and Medical Aid) in South Korea using the nationwide health insurance database. From 2002 to 2019, a total of 15,065 patients underwent either open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR). The primary outcome was AAA-related mortality, with follow-up conducted until death or December 31, 2019, for those without mortality records. Mortality was evaluated using Kaplan-Meier curves and an adjusted Cox proportional hazards model to identify independent risk factors for AAA-related mortality. Propensity score matching (PSM) was employed using relevant covariates to achieve a 1:10 match between the NHI and Medical Aid groups. Among the EVAR patients, the rate of AAA-related mortality was significantly higher in the Medical Aid group compared to the NHI group ( < 0.001). After adjusting for covariates, the difference in AAA-related mortality rates between the two insurance groups remained statistically significant. No significant difference was found between the two groups among OAR patients ( = 0.727). Factors such as age, insurance type, hypertension, diastolic blood pressure, hemoglobin levels, and glomerular filtration rate were significantly associated with AAA-related mortality in the unadjusted multivariable analysis among the EVAR patients. Specifically, Medical Aid patients had a 1.87-fold higher risk of AAA-related mortality compared to NHI patients. Notably, in the PSM cohort, multivariable analysis confirmed that insurance type remained a significant factor for AAA-related mortality in EVAR patients. In patients undergoing EVAR for AAA, insurance type was independently associated with postoperative AAA-related mortality, with Medical Aid patients experiencing worse outcomes. In contrast, no significant difference in AAA-related mortality was observed between insurance types among patients undergoing OAR. These findings highlight the need to improve postoperative care and address outcome disparities in vulnerable populations undergoing EVAR. Abdominal aortic aneurysm (AAA) is associated with a high mortality rate if left untreated, and medically vulnerable populations experience significant disparities in treatment and outcomes. We investigated the characteristics and treatment outcomes of AAA according to the insurance type (i.e., National Health Insurance [NHI] and Medical Aid) in South Korea using the nationwide health insurance database.BACKGROUNDAbdominal aortic aneurysm (AAA) is associated with a high mortality rate if left untreated, and medically vulnerable populations experience significant disparities in treatment and outcomes. We investigated the characteristics and treatment outcomes of AAA according to the insurance type (i.e., National Health Insurance [NHI] and Medical Aid) in South Korea using the nationwide health insurance database.From 2002 to 2019, a total of 15,065 patients underwent either open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR). The primary outcome was AAA-related mortality, with follow-up conducted until death or December 31, 2019, for those without mortality records. Mortality was evaluated using Kaplan-Meier curves and an adjusted Cox proportional hazards model to identify independent risk factors for AAA-related mortality. Propensity score matching (PSM) was employed using relevant covariates to achieve a 1:10 match between the NHI and Medical Aid groups.METHODSFrom 2002 to 2019, a total of 15,065 patients underwent either open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR). The primary outcome was AAA-related mortality, with follow-up conducted until death or December 31, 2019, for those without mortality records. Mortality was evaluated using Kaplan-Meier curves and an adjusted Cox proportional hazards model to identify independent risk factors for AAA-related mortality. Propensity score matching (PSM) was employed using relevant covariates to achieve a 1:10 match between the NHI and Medical Aid groups.Among the EVAR patients, the rate of AAA-related mortality was significantly higher in the Medical Aid group compared to the NHI group (P < 0.001). After adjusting for covariates, the difference in AAA-related mortality rates between the two insurance groups remained statistically significant. No significant difference was found between the two groups among OAR patients (P = 0.727). Factors such as age, insurance type, hypertension, diastolic blood pressure, hemoglobin levels, and glomerular filtration rate were significantly associated with AAA-related mortality in the unadjusted multivariable analysis among the EVAR patients. Specifically, Medical Aid patients had a 1.87-fold higher risk of AAA-related mortality compared to NHI patients. Notably, in the PSM cohort, multivariable analysis confirmed that insurance type remained a significant factor for AAA-related mortality in EVAR patients.RESULTSAmong the EVAR patients, the rate of AAA-related mortality was significantly higher in the Medical Aid group compared to the NHI group (P < 0.001). After adjusting for covariates, the difference in AAA-related mortality rates between the two insurance groups remained statistically significant. No significant difference was found between the two groups among OAR patients (P = 0.727). Factors such as age, insurance type, hypertension, diastolic blood pressure, hemoglobin levels, and glomerular filtration rate were significantly associated with AAA-related mortality in the unadjusted multivariable analysis among the EVAR patients. Specifically, Medical Aid patients had a 1.87-fold higher risk of AAA-related mortality compared to NHI patients. Notably, in the PSM cohort, multivariable analysis confirmed that insurance type remained a significant factor for AAA-related mortality in EVAR patients.In patients undergoing EVAR for AAA, insurance type was independently associated with postoperative AAA-related mortality, with Medical Aid patients experiencing worse outcomes. In contrast, no significant difference in AAA-related mortality was observed between insurance types among patients undergoing OAR. These findings highlight the need to improve postoperative care and address outcome disparities in vulnerable populations undergoing EVAR.CONCLUSIONIn patients undergoing EVAR for AAA, insurance type was independently associated with postoperative AAA-related mortality, with Medical Aid patients experiencing worse outcomes. In contrast, no significant difference in AAA-related mortality was observed between insurance types among patients undergoing OAR. These findings highlight the need to improve postoperative care and address outcome disparities in vulnerable populations undergoing EVAR.
Author	Jang, Won Mo Choi, Hong-Jae Oh, Se Jin Lim, Joon Seo
Author_xml	– sequence: 1 givenname: Hong-Jae orcidid: 0000-0002-1931-1883 surname: Choi fullname: Choi, Hong-Jae organization: Department of Thoracic and Cardiovascular Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea – sequence: 2 givenname: Joon Seo orcidid: 0000-0002-2738-5882 surname: Lim fullname: Lim, Joon Seo organization: Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea – sequence: 3 givenname: Won Mo orcidid: 0000-0003-3277-7706 surname: Jang fullname: Jang, Won Mo organization: Department of Public Health and Community Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea., Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea – sequence: 4 givenname: Se Jin orcidid: 0000-0002-1516-5313 surname: Oh fullname: Oh, Se Jin organization: Department of Thoracic and Cardiovascular Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Snippet	Abdominal aortic aneurysm (AAA) is associated with a high mortality rate if left untreated, and medically vulnerable populations experience significant... Background: Abdominal aortic aneurysm (AAA) is associated with a high mortality rate if left untreated, and medically vulnerable populations experience...
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SubjectTerms	Aged Aged, 80 and over Aortic Aneurysm, Abdominal - mortality Aortic Aneurysm, Abdominal - pathology Aortic Aneurysm, Abdominal - surgery Databases, Factual Endovascular Procedures Female Healthcare Disparities Humans Insurance, Health Kaplan-Meier Estimate Male Middle Aged National Health Programs Propensity Score Proportional Hazards Models Republic of Korea - epidemiology Risk Factors Socioeconomic Disparities in Health Socioeconomic Factors Treatment Outcome 의학일반
Title	Association Between Health Insurance Type and Survival Outcomes: Insight Into the Impact of Socioeconomic Disparities in the Postoperative Outcomes of Abdominal Aortic Aneurysm in Korea
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