Impact of regional medical self-sufficiency on mortality from cancer, stroke and myocardial infarction

OBJECTIVES: This study aimed to explore the impact of regional medical self-sufficiency on mortality from cancer, stroke and myocardial infarction (MI), and make policy suggestions to address regional health disparities and promote national health outcomes. STUDY DESIGN: A multilevel analysis of nationwide data. METHODS: This study employed the Korean National Health Insurance Service-National Sample Cohort database at the individual level and the Korean Medical Utilization Statistics at the regional level. The study population included 31,862 individuals who were newly diagnosed with cancer, 16,793 with stroke and 2936 with MI between 2011 and 2019. Multilevel logistic regression was used to address the clustered structure of regional-level data with individual-level data on demographics and health details nested within it. RESULTS: Regional medical self-sufficiency did not significantly impact 1-year mortality in cancer patients. For patients with stroke and MI, a low level of medical self-sufficiency in the residential area was associated with a notably increased likelihood of dying within 1 month by 1.03 (95 % confidence interval [CI]: 1.02-1.07) and 1.44 (95 % CI: 1.08-2.01) times, respectively. Stratified analysis by region of residence showed that even if cancer patients lived in Seoul and metropolitan areas, they had an increased risk of death within 1 year if the medical self-sufficiency of their treatment areas was low (adjusted odds ratio [aOR]: 1.19, 95 % CI: 1.03-1.38). Moreover, for patients with MI living in medically underserved areas, the risk of death tended to increase with lower income. CONCLUSIONS: The findings demonstrated that for acute stroke or MI patients, living in areas with low self-sufficiency of medical care had a higher likelihood of dying within 1 month. To improve national health outcomes and address regional medical disparities, it is crucial to prioritise policies such as establishing specialised centres dedicated to managing acute cardio-cerebrovascular conditions in each region.