Impact of Regional Comprehensive Cardiovascular Disease Centers on Mortality in Korea

Impact of Regional Comprehensive Cardiovascular Disease Centers on Mortality in Korea | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Impact of Regional Comprehensive Cardiovascular Disease Centers on Mortality in Korea Ye Seul Jang, Soo Young Kim, Eun-Cheol Park This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4559463/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Cardiovascular disease (CVD) remains an important global contributor to mortality and morbidity, with South Korea experiencing higher fatality rates from acute CVD despite excellent hospital care. We investigated regional CVD centers in Korea’s impact on CVD-related mortality rates. This population-based cohort study obtained data from the 2002–2019 Korean National Health Insurance Service–National Sample Cohort. Eleven of the 15 regional CVD centers were included in the study. For the 2 years pre- and post-establishment of the regional CVD centers, 15,687 patients’ data were included in the study. The inclusion criteria included ( 1 ) having consulted at an emergency room (ER) with the principal diagnosis of acute CVD, including ischemic and hypertensive CVD, and ( 2 ) residing in the area where the regional CVD center was established during the study cohort period. Patients not meeting these criteria were excluded. The dependent variable, CVD-related mortality, included mortalities occurring within 30, 60, and 90 days of the first consultation at the ER. To analyze the time trend and its change in outcomes, an interrupted time-series analysis with segmented regression was performed. There were 8,009 and 7,678 patients in the pre- and post-intervention cohorts, respectively. The probability of death within 30 days after an ER (or regional CVD center) visit among patients with acute heart disease decreased following the designation of the regional CVD center in that area (estimate, 0.9570; 95% confidence interval, 0.9213–0.9942). The designation of regional CVD centers, as part of the government health policy, reduces the acute CVD-related 30-day mortality in patients who have consulted at the ER. cardiovascular disease emergency room interrupted time-series analysis 30-day mortality regional cardiovascular center Figures Figure 1 Introduction Despite considerable advancements aimed at enhancing favorable clinical outcomes over the past few decades, cardiovascular disease (CVD) remains a prominent global contributor to both mortality and morbidity 1–3 . According to the Centers for Disease Control and Prevention in the United States of America (USA) 4 , approximately 695,000 people in the USA died from CVD in 2021, equivalent to 1 in every 5 deaths. Furthermore, CVD has cost the USA approximately 239.9 billion dollars annually between 2018 and 2019. Korea’s CVD mortality rate was 61.5 per 100,000 people in 2021, with the incidence of CVD increasing by 11.7% from 2011. 5 According to the Health Insurance Review and Assessment Service of Korea, which is a national institute that assesses national health insurance claims, in 2022, CVD-related medical expenses were 2.5391 trillion won, an increase of 38.5% from 2018. 6 According to the 2012 Organization for Economic Cooperation and Development (OECD) Health Care Quality Reviews in Korea, a “paradox” exists in South Korea. Although acute hospital care is excellent, the case fatality rates for acute myocardial infarction are higher than those in other OECD countries. 7 This phenomenon can largely be attributed to the inadequate prevention of CVD risk factors and suboptimal emergency response systems 8 . Other factors include substandard post-acute care and substantial differences in the healthcare quality between rural and urban areas. Access to medical care within a community is one of the most important factors affecting patient survival. Thus, the time from the CVD incident to treatment is crucial for a positive outcome. Accordingly, as of 2008, the Korean government has implemented a policy to select and implement regional CVD centers by developing regional, specialized, treatment-based hospitals. These institutions encompass an established treatment system, with the emergency management and early rehabilitation of CVD occurring within 3 h from symptom onset anywhere in the country. The objective thereof is to improve the level of community healthcare. 9 By 2022, regional CVD and cerebrovascular disease centers were established in 15 regions, excluding Seoul. Moreover, these centers are continuously evaluated regarding their effectiveness in improving treatment outcomes for CVD and cerebrovascular diseases and in reducing the gap in mortality rates by region. 10 Consequently, in this study, we aimed to investigate how the regional mortality rate due to acute CVD has changed based on the time points pre- and post-establishment of the regional CVD centers of Korea. We used the National Health Insurance Service–National Sample Cohort (NHIS–NSC), which included patients with CVDs, to determine the effectiveness of these regional, specialized centers. Methods Data and Study Population This population-based cohort study’s data were extracted from South Korea’s NHIS–NSC 2002–2019 database. Since the introduction of universal health coverage in 1989, all South Korean citizens have been obligated to enroll in the NHIS–NSC. Therefore, approximately 98% of South Korea’s total population is included in this database. The National Health Information Database has been developed by the Korean National Health Insurance Service, comprising the personal demographic records of enrolled patients to collect insurance premiums and subscription data for reimbursement. 11 The inclusion criteria were as follows: ( 1 ) having consulted at an emergency room (ER) with the principal diagnosis of acute CVD, as per the 10th revision of the International Classification of Diseases (ICD-10) codes, I20–I24, I50, and I51, which encompassed ischemic and hypertensive CVD; and ( 2 ) residing in the area where a regional CVD center was established during the study cohort period, allowing us to evaluate the time period, 2 years pre- and post-establishment of the center. Patients not meeting these criteria were excluded. Variables CVD-related mortality, which was the dependent variable in our study, included mortalities occurring within 30, 60, and 90 days of the first consultation at the ER. The primary independent variable of interest in this study was the time pre- and post-establishment of the regional CVD center. A total of 2 years pre- and post-establishment were investigated. Furthermore, because the time point of each regional CVD center’s establishment was different, the time point was set to zero at the establishment date. Therefore, only 11 of the 15 regional CVD center regions were included in the study. These regions included Kangwon, Jeju, Daegu, Kyungbuk, Kyungnam, Jeonnam, Gwangju, Chungbuk, Busan, Jeongbuk, Chungnam, Daejeon, Incheon, and Kyunggi. When analyzing the correlation between changes in CVD-related mortality and the establishment of specialized regional CVD centers, the following covariates were adjusted for: age; sex; income at the 10th decile, health insurance status; presence of a disability; the Charlson Comorbidity Index (CCI); first year after the ER consultation; whether percutaneous coronary intervention (PCI) 12 had been performed; and the presence of comorbidities, such as hypertension and diabetes mellitus. Periods pre- and post-establishment of the regional CVD center were defined as the pre- and post-intervention periods, respectively. Statistical Analysis Descriptive statistics were presented as frequencies and percentages. An interrupted time-series (ITS) analysis with segmented regression was performed to determine time trends and changes in the outcomes, as previously described 13 . The ITS analysis was developed using a linear regression model, which included three time-related variables. The regression coefficients estimated the pre-intervention slope, level change at the time of the intervention, and post-intervention slope. Slope change quantified the difference between the pre- and post-intervention slopes. Level changes represented an absolute change in the level of outcomes at the time of the intervention and measured the immediate effect of the intervention 14 . We applied the log-link function to the generalized linear regression model to perform segmented regression. Therefore, the model coefficients had to be converted into exponentials to represent trends and changes in the outcomes on the original scale. log (µi)= β0 + β1 × timet + β2 × interventiont + β3 × time after interventiont + et ( 1 ) In this model, the intercept β0 is used to predict the initial status of the outcome. β1 provides an estimate of the initial trend of the outcome before any intervention. β2 is used to assess the immediate impact of the intervention, revealing how the level of the outcome has changed directly post-intervention. β3 calculates the shift in the trend post-intervention. Additionally, the combined effect of β1 and β3 represents the ongoing trend of the outcome post-intervention, reflecting how the outcome has evolved over time. The principal findings of the analyses included the parameter estimates, standard errors (SEs), and P- values. All estimates were exponentiated, using adjusted risk ratios and 95% confidence intervals (CIs). The statistical software package, SAS, version 9.4 (SAS Institute Inc., Cary, North Carolina, USA), was used for all analyses. Statistical significance was set at a two-sided P < .05. Results Table 1 presents the demographic characteristics of the patients with the frequencies of the pre- and post-intervention cohorts. The number of patients in the pre- and post-intervention cohorts was 8,009 and 7,678, respectively. Regarding regions, Jeju had the smallest proportion of patients, whereas Kyunggi had the largest proportion of patients. Patients with work-sponsored insurance and those with higher CCI scores comprised a larger proportion of the total study population. Table 2 and Fig. 1 present the results of the parameter estimates, SEs, and P -values from the segmented regression models with the predicted outcomes. As depicted in Table 2 , the size of the level and trend changes could be quantitatively confirmed by calculating the parameter estimates, while, as shown in Fig. 1 , intuitively confirming the post-intervention outcome trends was possible. Table 1. Demographic characteristics of the study population Variable Establishment of regional cardiovascular centers in each region (n= 15 687) Pre-intervention Post-intervention Total (n= 8009) Mortality Total (n= 7678) Mortality No % Yes % No % Yes % Sex Male 4172 4093 98.11 79 1.89 4199 4127 98.29 72 1.71 Female 3837 3757 97.92 80 2.08 3479 3411 98.05 68 1.95 Age (years) <30 205 193 94.15 12 5.85 147 140 95.24 7 4.76 30–39 206 204 99.03 2 0.97 176 175 99.43 1 0.57 40–49 677 672 99.26 5 0.74 669 660 98.65 9 1.35 50–59 1693 1679 99.17 14 0.83 1662 1649 99.22 13 0.78 60–69 2222 2196 98.83 26 1.17 2020 1996 98.81 24 1.19 70–79 2185 2131 97.53 54 2.47 2102 2070 98.48 32 1.52 ≥80 821 775 94.40 46 5.60 902 848 94.01 54 5.99 Insurance type Work-sponsored 5234 5131 98.03 103 1.97 5070 4979 98.21 91 1.79 Regional 2775 2719 97.98 56 2.02 2531 2484 98.14 47 1.86 Medical aid 0 0 0.00 0 0.00 77 75 97.40 2 2.60 Income (10th decile) 1 (0–3) 1694 1665 98.29 29 1.71 1641 1602 97.62 39 2.38 2 (4–7) 3666 3584 97.76 82 2.24 3390 3337 98.44 53 1.56 3 (8–10) 2649 2601 98.19 48 1.81 2647 2599 98.19 48 1.81 Disability No 6884 6760 98.20 124 1.80 6581 6478 98.43 103 1.57 Yes 1125 1090 96.89 35 3.11 1097 1060 96.63 37 3.37 Charlson Comorbidity Index 0 1215 1191 98.02 24 1.98 958 939 98.02 19 1.98 1 2118 2073 97.88 45 2.12 1901 1860 97.84 41 2.16 2 1940 1907 98.30 33 1.70 1915 1883 98.33 32 1.67 3 2736 2679 97.92 57 2.08 2904 2856 98.35 48 1.65 Region Gangwon 313 310 99.04 3 0.96 292 285 97.60 7 2.40 Jeju 126 120 95.24 6 4.76 77 77 100.00 0 0.00 Daegu and Kyungbuk 1171 1147 97.95 24 2.05 800 785 98.13 15 1.88 Kyungnam 694 688 99.14 6 0.86 550 535 97.27 15 2.73 Jeonnam and Gwangju 861 845 98.14 16 1.86 620 610 98.39 10 1.61 Chungbuk 380 368 96.84 12 3.16 253 244 96.44 9 3.56 Busan 842 825 97.98 17 2.02 562 544 96.80 18 3.20 Jeonbuk 473 468 98.94 5 1.06 313 312 99.68 1 0.32 Daejeon and Chungnam 809 790 97.65 19 2.35 620 599 96.61 21 3.39 Incheon 514 505 98.25 9 1.75 708 700 98.87 8 1.13 Kyunggi 1826 1784 97.70 42 2.30 2883 2847 98.75 36 1.25 Percutaneous coronary intervention No 6780 6653 98.13 127 1.87 6490 6379 98.29 111 1.71 Yes 1229 1197 97.40 32 2.60 1188 1159 97.56 29 2.44 Hypertension No 6877 6739 97.99 138 2.01 6679 6567 98.32 112 1.68 Yes 1132 1111 98.14 21 1.86 999 971 97.20 28 2.80 Diabetes mellitus No 7536 7386 98.01 150 1.99 722 591 81.86 131 18.14 Yes 473 464 98.10 9 1.90 436 427 97.94 9 2.06 Year 2007 18 17 94.44 1 5.56 0 0 0.00 0 0.00 2008 896 879 98.10 17 1.90 0 0 0.00 0 0.00 2009 2007 1968 98.06 39 1.94 4 4 100.00 0 0.00 2010 1737 1715 98.73 22 1.27 515 508 98.64 7 1.36 2011 756 735 97.22 21 2.78 1468 1436 97.82 32 2.18 2012 255 247 96.86 8 3.14 1319 1284 97.35 35 2.65 2013 1150 1127 98.00 23 2.00 575 558 97.04 17 2.96 2014 974 949 97.43 25 2.57 206 201 97.57 5 2.43 2015 216 213 98.61 3 1.39 1833 1812 98.85 21 1.15 2016 0 0 0.00 0 0.00 1587 1567 98.74 20 1.26 2017 0 0 0.00 0 0.00 171 168 98.25 3 1.75 Table 3. Sub-analysis stratified by sex, age, insurance type, and income level Mortality within 30 days after patients consulting at an emergency room with acute cardiovascular disease Exp (β0) Exp (β1) Exp (β2) Exp (β3) ( P -value) a ( P -value) a ( P -value) a ( P -value) a Sex Male 0.0049 1.0898 0.6057 0.9590 (0.0018) (0.0016) (0.2283) (0.1356) Female 0.0003 1.1107 0.9638 0.9542 <.001 <.001 (0.9251) (0.0889) Age (years) <30 0.0000 1.2487 0.4839 0.9227 < .001 (0.3194) (0.6333) (0.4104) 30–39 0.0000 0.5550 0.0000 1.3730 - - - - 40–49 0.0020 0.9753 2.2553 1.0684 (0.9999) (0.8177) (0.5698) (0.5133) 50–59 0.0000 1.0650 0.5341 0.8815 <.001 (0.3408) (0.4931) (0.0812) 60–69 1.5214 1.0959 1.2213 0.9751 <.001 (0.0519) (0.7907) (0.6026) 70–79 0.0000 1.0922 0.9094 0.9815 <.001 (0.0090) (0.8420) (0.6032) ≥80 0.0018 1.1529 0.5190 0.9177 (0.0008) (0.0001) (0.1960) (0.0222) Insurance type Work-sponsored 0.0001 1.1183 0.5169 0.9475 <.001 <.001 (0.0681) (0.0276) Regional 0.0000 1.0754 1.3290 0.9683 <.001 (0.0258) (0.5569) (0.3379) Medical aid - - - - Income (10th decile) 1 (0–3) 0.0004 1.1266 1.5708 0.9159 (0.0006) (0.0050) (0.4144) (0.0317) 2 (4–7) 0.0000 1.0980 0.5647 0.9332 <.001 (0.0008) (0.1922) (0.0279) 3 (8–10) 0.0001 1.0834 0.7213 0.9991 <.001 (0.0215) (0.5300) (0.9793) Disability No 0.0101 1.0937 0.6150 0.9474 (0.0013) <.001 (0.1295) (0.0173) Yes 0.0000 1.0926 1.7301 0.9873 <.001 (0.0293) (0.3818) (0.7422) a Statistical significance is set at a two-sided P <.05. Table 4. Sub-analysis stratified by mortality within 60 and 90 days of patients consulting at an emergency room with cardiovascular disease Parameter Exp (β) Exp (SE(β)) 95% confidence interval P -value a 60-day mortality Intercept β0 0.0107 2.9003 0.0013 0.0866 <.0001 Baseline trend β1 1.0860 1.0169 1.0509 1.1224 <.0001 Level change β2 0.6730 1.2822 0.4134 1.0956 0.1112 Trend change β3 0.9760 1.0171 0.9440 1.0090 0.1524 Follow-up outcome trend β1+β3 1.0528 1.0180 1.0519 1.0537 0.0011 90-day mortality Intercept β0 0.0158 2.7020 0.0022 0.1106 <.0001 Baseline trend β1 1.0897 1.0159 1.0564 1.1240 <.0001 Level change β2 0.7566 1.2614 0.4800 1.1926 0.2296 Trend change β3 0.9622 1.0161 0.9325 0.9929 0.0161 Follow-up outcome trend β1+β3 1.0525 1.0168 1.0517 1.0534 0.0046 a Statistical significance is set at a two-sided P<.05. The results of the ITS analysis revealed that the probability of mortality within 30 days of patients consulting at an ER or regional CVD center decreased in those with CVD post-establishment of a regional CVD center. As presented in Fig. 1 , an increasing trend is observed (estimate = 1.0967; 95% CI: 1.0193–1.0564; P < .0001). However, the probability of mortality within 30 days of patients consulting at an ER or regional CVD center decreased by 2.66% when compared with that before the establishment of a regional CVD center (estimate = 0.9570; 95% CI: 0.9213–0.9942). Moreover, β2, which revealed the immediate level change after the intervention, decreased; however, this decrease was not significant (estimate = 0.7652; 95% CI: 0.4399–1.3311). Table 3 presents the sub-cohort analyses stratified using the covariates, including sex, age, insurance type, and income level, correlated with mortality within 30 days of patients consulting at an ER with acute CVD. All remaining covariates other than the ones that were stratified were statistically adjusted to calculate the estimates. Increasing trends in the 30-day mortality pre-intervention that decreased post-intervention were noted in the oldest patients, in addition to patients with work-sponsored insurance, a low decile income level, those without disabilities, and patients who had not undergone PCIs; all values were significant. Table 4 presents the sub-cohort analyses stratified by mortality occurring within 60 and 90 days of patients consulting at an ER with acute CVD. The probability of mortality within 90 days of patients consulting at an ER with acute CVD significantly decreased (estimate = 0.9622; 95% CI: 0.9325–0.9929). A non-significant decrease in the 60-day mortality was also observed. Discussion In this study, we examined how the regional 30-day mortality due to acute CVD had changed based on the time points of pre- and post-establishment (pre- and post-intervention) of regional CVD centers in South Korea. Our results revealed a significant increase in the 30-day mortality during the pre-intervention period. Conversely, a significant decrease in the 30-day mortality during the post-intervention period was observed. An immediate decrease in the effect of policy intervention was observed; however, these values were not significant. Multiple previous studies have investigated the clinical outcomes of regional CVD centers, and their results align with our findings. Regarding the accessibility of medical care for CVDs, areas with poor medical access have been shown to have worse health outcome-related indicators, compared with areas without appropriate medical access 15 . National research projects have examined the direct effect of the regional specialized CVD centers on mortality rates. Moreover, studies have analyzed the impact of ER arrival time on patient prognosis and ER medical expenses. 16 In addition to primary prevention and rehabilitation, creating a well-functioning national healthcare system that ensures the timely and appropriate treatment of patients with acute conditions during the critical early period remains a crucial objective 17 . According to a study by Wang et al., delay in the arrival time is proportionately related to a worse prognosis and greater ER medical expenses. Moreover, in a study that analyzed the impact of regional emergency medical resources on the mortality rate of older adult patients with ischemic CVD, ample medical resources have been found to decrease the mortality rates. 18 The Regional Cardiocerebrovascular Center Project for the treatment of acute myocardial infarction revealed shortened door-to-balloon time in patients with ST-segment elevation myocardial infarctions (STEMIs) undergoing primary PCIs. 19 This project supports the media campaign regarding STEMI symptoms, prompt ER consultations, use of ambulances, and patient education. Cooperation between regional emergency centers and CVD centers will improve the survival of patients with acute CVD. Furthermore, many studies have focused on how regional CVD centers can strengthen medical accessibility for patients in remote rural areas. Potential difficulties arise from the disparities in medical accessibility in rural areas. 20 The migration of people from rural areas to cities is the cause of this social dilemma. Thus, the sudden decrease in these rural populations has rendered medical institutions obsolete or non-profitable. However, as most people who have remained in rural areas are patients in need of medical assistance, the government has created policies that could encourage the settling of healthcare personnel and the preservation of medical institutions in rural areas 21,22 . Despite these efforts, particularly regarding the resolution of the accessibility challenge, a concern involving the quality of healthcare remains. Rural areas do not attract the best doctors, and they lack opportunities for career progression 23 . This issue is challenging; however, policymakers must manage and implement strategies that promote the quality of healthcare in rural areas. Moreover, in their research encompassing eight states of the USA, Probst et al. found that rural residents without access to community health centers are more likely to be hospitalized for conditions and that primary care of acceptable quality can reduce the frequency of these hospitalizations 24 . Schroen et al. found that access to medical centers for chronic diseases may drastically reduce surgical interventions, such as mastectomies, where radiotherapy is unavailable. 25,26 Therefore, regional CVD centers increase the accessibility and abundance of medical resources to patients in rural areas, resulting in a higher quality of medical practice and potentially better health outcomes. This study has a few limitations, which should be considered when interpreting the results. First, our definitions of CVD relied on ICD-10 codes, which are susceptible to errors, such as miscoding, potentially introducing classification bias. Second, owing to the use of medical claims data, factors such as baseline health status and other health-related variables could not be considered. Nevertheless, the CCI score was adjusted. Variables related to the time spent in the ER and treatment-related variables could have elevated the extent of this analysis. Third, we may have underestimated the target population because patients who had been billed for emergency management fees were included in the analysis. Patients who did not claim emergency management fees may additionally be at risk of acute CVD; thus, further investigations are required. Finally, this study had a retrospective, cross-sectional design; thus, data could potentially have been missing or not recorded. Notably, despite these limitations, we utilized the NHIS–NSC database, which offered a substantial and nationally representative sample cohort derived from comprehensive health insurance data. This approach allowed us to address the limitations commonly associated with cross-sectional data, improving the applicability of our findings. In conclusion, the findings of this nationwide cohort study suggest that designating regional CVD centers as part of government health policy in rural areas decreases the 30-day CVD-related mortality in patients who consult at ERs. Considering the high mortality rates related to CVD in South Korea, policies to reduce these rates should be further developed and implemented. Declarations Acknowledgments We would thanks to our colleagues from the Department of Public Health, Graduate School of Yonsei University who provided advice for this manuscript. Author contributions Conceptualization: Y.S.J, S.Y.K, E-C P. Data curation: Y.S.J, S.Y.K Formal analysis: S.Y.J, S.Y/L Methodology: Y.S.J, S.Y.K, E-C P. Writing - review & editing: Y.S.J, S.Y.K, E-C P. Data availability statement The Korean National Health Insurance Service–National Sample Cohort is an open-access public database. It comprises health insurance claim data for all Koreans. The sample cohort can be used for public purposes and scientific research, accessible upon approval from the national health insurance service. (https://nhiss.nhis.or.kr/bd/ab/bdaba000eng.do) Additional information: None Competing interests The authors declare no competing interests. References World Health Organization. World health statistics 2020. 2020. Rossello X, Pocock SJ, Julian DG. Long-term use of cardiovascular drugs: challenges for research and for patient care. Journal of the American College of Cardiology 2015;66:1273-85. Rossello X, Ariti C, Pocock SJ, Ferreira JP, Girerd N, McMurray JJ, et al. 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How an aging society affects the economic costs of inactivity in Germany: empirical evidence and projections. European review of aging and physical activity 2017;14:1-9. Mohammadiaghdam N, Doshmangir L, Babaie J, Khabiri R, Ponnet K. Determining factors in the retention of physicians in rural and underdeveloped areas: a systematic review. BMC Fam Pract 2020;21:216. Probst JC, Laditka JN, Laditka SB. Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states. BMC Health Serv Res 2009;9:134. Weeks WB, Bott DM, Lamkin RP, Wright SM. Veterans Health Administration and Medicare outpatient health care utilization by older rural and urban New England veterans. The Journal of Rural Health 2005;21:167-71. Schroen AT, Brenin DR, Kelly MD, Knaus WA, Slingluff Jr CL. Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients. Journal of clinical oncology 2005;23:7074-80. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4559463","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":318781771,"identity":"84b2d43a-9207-4de1-bffb-229dff03fd7e","order_by":0,"name":"Ye Seul Jang","email":"","orcid":"","institution":"Yonsei University","correspondingAuthor":false,"prefix":"","firstName":"Ye","middleName":"Seul","lastName":"Jang","suffix":""},{"id":318781772,"identity":"f3b2281c-6245-4845-b0eb-16d47fba6e07","order_by":1,"name":"Soo Young Kim","email":"","orcid":"","institution":"Yonsei University","correspondingAuthor":false,"prefix":"","firstName":"Soo","middleName":"Young","lastName":"Kim","suffix":""},{"id":318781773,"identity":"11b6dde5-4b93-413d-a0c3-c54cafb6bb2d","order_by":2,"name":"Eun-Cheol Park","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYBAC+/bzDw7/bLNhYJAgVosBT47hY96eNFK0SOgYG/POOEySFh4zad4N5xM33G5/wPCjhggt9hL8z6R/PriduOHOGQPGnmPE2cIm/RCk5UYOAwNvA3Fa2H8bbjgH1JL+gPEvcVp02KQlZxwAakkwYCbOFp4cNmnenmTjmTdyDA7LEOMX+/YzQC1tdrJ9N9IfPnxDTIjBgCPISQdI0AC0jSTVo2AUjIJRMLIAAND4Oz/gY7RhAAAAAElFTkSuQmCC","orcid":"","institution":"Yonsei University","correspondingAuthor":true,"prefix":"","firstName":"Eun-Cheol","middleName":"","lastName":"Park","suffix":""}],"badges":[],"createdAt":"2024-06-10 17:16:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4559463/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4559463/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59606611,"identity":"2363b756-4a5b-468a-82b7-d9c98ed4737b","added_by":"auto","created_at":"2024-07-03 18:53:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":63508,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProbability of mortality within 30 days after patients consulting at an emergency room with cardiovascular disease\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4559463/v1/a28fadddb4aa99bf7fb3b2f1.png"},{"id":85645790,"identity":"df27601a-ac81-472c-ba8f-f9ce88442f4b","added_by":"auto","created_at":"2025-06-30 08:32:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1416586,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4559463/v1/ad66a488-f77d-4afc-af19-5151cd8a87ea.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Regional Comprehensive Cardiovascular Disease Centers on Mortality in Korea","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDespite considerable advancements aimed at enhancing favorable clinical outcomes over the past few decades, cardiovascular disease (CVD) remains a prominent global contributor to both mortality and morbidity\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e. According to the Centers for Disease Control and Prevention in the United States of America (USA)\u003csup\u003e4\u003c/sup\u003e, approximately 695,000 people in the USA died from CVD in 2021, equivalent to 1 in every 5 deaths. Furthermore, CVD has cost the USA approximately 239.9\u0026nbsp;billion dollars annually between 2018 and 2019.\u003c/p\u003e \u003cp\u003eKorea\u0026rsquo;s CVD mortality rate was 61.5 per 100,000 people in 2021, with the incidence of CVD increasing by 11.7% from 2011.\u003csup\u003e5\u003c/sup\u003e According to the Health Insurance Review and Assessment Service of Korea, which is a national institute that assesses national health insurance claims, in 2022, CVD-related medical expenses were 2.5391 trillion won, an increase of 38.5% from 2018.\u003csup\u003e6\u003c/sup\u003e According to the 2012 Organization for Economic Cooperation and Development (OECD) Health Care Quality Reviews in Korea, a \u0026ldquo;paradox\u0026rdquo; exists in South Korea. Although acute hospital care is excellent, the case fatality rates for acute myocardial infarction are higher than those in other OECD countries.\u003csup\u003e7\u003c/sup\u003e This phenomenon can largely be attributed to the inadequate prevention of CVD risk factors and suboptimal emergency response systems\u003csup\u003e8\u003c/sup\u003e. Other factors include substandard post-acute care and substantial differences in the healthcare quality between rural and urban areas.\u003c/p\u003e \u003cp\u003eAccess to medical care within a community is one of the most important factors affecting patient survival. Thus, the time from the CVD incident to treatment is crucial for a positive outcome. Accordingly, as of 2008, the Korean government has implemented a policy to select and implement regional CVD centers by developing regional, specialized, treatment-based hospitals. These institutions encompass an established treatment system, with the emergency management and early rehabilitation of CVD occurring within 3 h from symptom onset anywhere in the country. The objective thereof is to improve the level of community healthcare.\u003csup\u003e9\u003c/sup\u003e By 2022, regional CVD and cerebrovascular disease centers were established in 15 regions, excluding Seoul. Moreover, these centers are continuously evaluated regarding their effectiveness in improving treatment outcomes for CVD and cerebrovascular diseases and in reducing the gap in mortality rates by region.\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eConsequently, in this study, we aimed to investigate how the regional mortality rate due to acute CVD has changed based on the time points pre- and post-establishment of the regional CVD centers of Korea. We used the National Health Insurance Service\u0026ndash;National Sample Cohort (NHIS\u0026ndash;NSC), which included patients with CVDs, to determine the effectiveness of these regional, specialized centers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData and Study Population\u003c/h2\u003e \u003cp\u003eThis population-based cohort study\u0026rsquo;s data were extracted from South Korea\u0026rsquo;s NHIS\u0026ndash;NSC 2002\u0026ndash;2019 database. Since the introduction of universal health coverage in 1989, all South Korean citizens have been obligated to enroll in the NHIS\u0026ndash;NSC. Therefore, approximately 98% of South Korea\u0026rsquo;s total population is included in this database. The National Health Information Database has been developed by the Korean National Health Insurance Service, comprising the personal demographic records of enrolled patients to collect insurance premiums and subscription data for reimbursement.\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) having consulted at an emergency room (ER) with the principal diagnosis of acute CVD, as per the 10th revision of the International Classification of Diseases (ICD-10) codes, I20\u0026ndash;I24, I50, and I51, which encompassed ischemic and hypertensive CVD; and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) residing in the area where a regional CVD center was established during the study cohort period, allowing us to evaluate the time period, 2 years pre- and post-establishment of the center. Patients not meeting these criteria were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cp\u003eCVD-related mortality, which was the dependent variable in our study, included mortalities occurring within 30, 60, and 90 days of the first consultation at the ER. The primary independent variable of interest in this study was the time pre- and post-establishment of the regional CVD center. A total of 2 years pre- and post-establishment were investigated. Furthermore, because the time point of each regional CVD center\u0026rsquo;s establishment was different, the time point was set to zero at the establishment date. Therefore, only 11 of the 15 regional CVD center regions were included in the study. These regions included Kangwon, Jeju, Daegu, Kyungbuk, Kyungnam, Jeonnam, Gwangju, Chungbuk, Busan, Jeongbuk, Chungnam, Daejeon, Incheon, and Kyunggi.\u003c/p\u003e \u003cp\u003eWhen analyzing the correlation between changes in CVD-related mortality and the establishment of specialized regional CVD centers, the following covariates were adjusted for: age; sex; income at the 10th decile, health insurance status; presence of a disability; the Charlson Comorbidity Index (CCI); first year after the ER consultation; whether percutaneous coronary intervention (PCI)\u003csup\u003e12\u003c/sup\u003e had been performed; and the presence of comorbidities, such as hypertension and diabetes mellitus. Periods pre- and post-establishment of the regional CVD center were defined as the pre- and post-intervention periods, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were presented as frequencies and percentages. An interrupted time-series (ITS) analysis with segmented regression was performed to determine time trends and changes in the outcomes, as previously described\u003csup\u003e13\u003c/sup\u003e. The ITS analysis was developed using a linear regression model, which included three time-related variables. The regression coefficients estimated the pre-intervention slope, level change at the time of the intervention, and post-intervention slope. Slope change quantified the difference between the pre- and post-intervention slopes. Level changes represented an absolute change in the level of outcomes at the time of the intervention and measured the immediate effect of the intervention\u003csup\u003e14\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe applied the log-link function to the generalized linear regression model to perform segmented regression. Therefore, the model coefficients had to be converted into exponentials to represent trends and changes in the outcomes on the original scale.\u003c/p\u003e \u003cp\u003elog (\u0026micro;i)= β0\u0026thinsp;+\u0026thinsp;β1 \u0026times; timet\u0026thinsp;+\u0026thinsp;β2 \u0026times; interventiont\u0026thinsp;+\u0026thinsp;β3 \u0026times; time after interventiont\u0026thinsp;+\u0026thinsp;et (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn this model, the intercept β0 is used to predict the initial status of the outcome. β1 provides an estimate of the initial trend of the outcome before any intervention. β2 is used to assess the immediate impact of the intervention, revealing how the level of the outcome has changed directly post-intervention. β3 calculates the shift in the trend post-intervention. Additionally, the combined effect of β1 and β3 represents the ongoing trend of the outcome post-intervention, reflecting how the outcome has evolved over time.\u003c/p\u003e \u003cp\u003eThe principal findings of the analyses included the parameter estimates, standard errors (SEs), and \u003cem\u003eP-\u003c/em\u003evalues. All estimates were exponentiated, using adjusted risk ratios and 95% confidence intervals (CIs). The statistical software package, SAS, version 9.4 (SAS Institute Inc., Cary, North Carolina, USA), was used for all analyses. Statistical significance was set at a two-sided \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;1 presents the demographic characteristics of the patients with the frequencies of the pre- and post-intervention cohorts. The number of patients in the pre- and post-intervention cohorts was 8,009 and 7,678, respectively. Regarding regions, Jeju had the smallest proportion of patients, whereas Kyunggi had the largest proportion of patients. Patients with work-sponsored insurance and those with higher CCI scores comprised a larger proportion of the total study population.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e present the results of the parameter estimates, SEs, and \u003cem\u003eP\u003c/em\u003e-values from the segmented regression models with the predicted outcomes. As depicted in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, the size of the level and trend changes could be quantitatively confirmed by calculating the parameter estimates, while, as shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, intuitively confirming the post-intervention outcome trends was possible.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.53910149750416%\" colspan=\"8\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Demographic characteristics of the study population\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.820299500831947%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.820299500831947%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.820299500831947%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"85.88039867109634%\" colspan=\"10\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstablishment of regional cardiovascular centers in each region (n= 15 687)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.48742746615087%\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.42166344294004%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.76595744680851%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 8009)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.81237911025145%\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.864603481624759%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e7678)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.55705996131528%\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.75%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75%\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.75%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e4172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e4093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.11\u003c/p\u003e\n \u003c/td\u003e\n 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width=\"10.96345514950166%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e\u0026lt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e94.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e5.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e95.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e99.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e99.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e99.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e1693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e1679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e99.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e1662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e99.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e2222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e2196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e70\u0026ndash;79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e2185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e2131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e2102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e\u0026ge;80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e94.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e5.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e848\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e94.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e5.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.083056478405314%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eInsurance type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eWork-sponsored\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e5234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e5131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e5070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e4979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eRegional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e2775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e2719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e2531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eMedical aid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e97.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.083056478405314%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome (10th decile)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e1 (0\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e1694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e1665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e1641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e97.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e2 (4\u0026ndash;7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e3666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e3584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e3390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e3337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e3 (8\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e2649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e2601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e2647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e6884\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e6760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e6581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e6478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e1125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e1090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e96.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e1097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e96.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.333333333333336%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharlson Comorbidity Index\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.5%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e1215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e1191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e2118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e2073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e1901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e97.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e1940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e1907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e1915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e2736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e2679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e2904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eGangwon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e99.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e97.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eJeju\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e95.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eDaegu and Kyungbuk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e1171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e1147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eKyungnam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e99.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e97.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eJeonnam and Gwangju\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e845\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eChungbuk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e96.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e96.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e3.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eBusan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e96.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eJeonbuk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e99.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eDaejeon and Chungnam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e96.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eIncheon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eKyunggi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e1826\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e1784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e2883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.261231281198%\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercutaneous coronary intervention\u003c/strong\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.151414309484194%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.820299500831947%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.48585690515807%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.820299500831947%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.820299500831947%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.820299500831947%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.820299500831947%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e6780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e6653\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e6490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e6379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e1229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e1197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e1188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e97.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e6877\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e6739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n 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\u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e97.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e7536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e7386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e81.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e18.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n 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width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e1968\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n 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width=\"9.136212624584717%\"\u003e\n \u003cp\u003e247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e96.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e1319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e97.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e1150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e1127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e97.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e97.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e97.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e98.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e1833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e1587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.96345514950166%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.136212624584717%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.471760797342192%\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e98.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.807308970099668%\"\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1719486370.png\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3. Sub-analysis stratified by sex, age, insurance type, and income level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"73.10756972111554%\" colspan=\"4\"\u003e\n \u003cp\u003eMortality within 30 days after patients consulting at an emergency room with acute cardiovascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExp (\u0026beta;0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExp (\u0026beta;1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExp (\u0026beta;2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExp (\u0026beta;3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003eP\u003c/em\u003e-value)\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003eP\u003c/em\u003e-value)\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003eP\u003c/em\u003e-value)\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003cem\u003eP\u003c/em\u003e-value)\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.0049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.0898\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.6057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e0.9590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.0018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.0016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.2283)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e(0.1356)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.1107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.9638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e0.9542\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.9251)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e(0.0889)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e\u0026lt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.2487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.4839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e0.9227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.3194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.6333)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e(0.4104)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.5550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd 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width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.1183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.5169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.9475\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.0681)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.0276)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n 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width=\"19.880715705765407%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e1 (0\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.0004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.1266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.5708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.9159\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.0006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.0050)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.4144)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.0317)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e2 (4\u0026ndash;7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.0980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.5647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.9332\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.0008)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.1922)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.0279)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e3 (8\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.0834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.7213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e0.9991\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.0215)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.5300)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e(0.9793)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.0101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.0937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.6150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.9474\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.0013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.1295)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(0.0173)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e0.0000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.0926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e1.7301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e0.9873\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.89243027888446%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.0293)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.729083665338646%\"\u003e\n \u003cp\u003e(0.3818)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.9203187250996%\"\u003e\n \u003cp\u003e(0.7422)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\u003csup\u003ea\u003c/sup\u003eStatistical significance is set at a two-sided \u003cem\u003eP\u003c/em\u003e\u0026lt;.05.\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4. Sub-analysis stratified by mortality within 60 and 90 days of patients consulting at an emergency room with cardiovascular disease\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExp (\u0026beta;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExp (SE(\u0026beta;))\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.25581395348837%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% confidence interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.966777408637874%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e60-day mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003eIntercept \u0026beta;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e0.0107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e2.9003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e0.0013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e0.0866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003eBaseline trend \u0026beta;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.0860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.0169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.0509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.1224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003eLevel change \u0026beta;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e0.6730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.2822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e0.4134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.0956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e0.1112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003eTrend change \u0026beta;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e0.9760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.0171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e0.9440\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.0090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e0.1524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003eFollow-up outcome trend \u0026beta;1+\u0026beta;3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.0528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.0180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.0519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.0537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e0.0011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"59.966777408637874%\" colspan=\"3\"\u003e\n \u003cp\u003e90-day mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003eIntercept \u0026beta;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e0.0158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e2.7020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e0.0022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e0.1106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003eBaseline trend \u0026beta;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.0897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.0159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.0564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.1240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003eLevel change \u0026beta;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e0.7566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.2614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e0.4800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.1926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e0.2296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003eTrend change \u0026beta;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.9622\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0161\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.9325\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.9929\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0161\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003eFollow-up outcome trend \u0026beta;1+\u0026beta;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.0525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e1.0168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.0517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e1.0534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e0.0046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.093023255813954%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.93687707641196%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.627906976744185%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.777408637873755%\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eStatistical significance is set at a two-sided P\u0026lt;.05.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003eThe results of the ITS analysis revealed that the probability of mortality within 30 days of patients consulting at an ER or regional CVD center decreased in those with CVD post-establishment of a regional CVD center. As presented in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, an increasing trend is observed (estimate\u0026thinsp;=\u0026thinsp;1.0967; 95% CI: 1.0193\u0026ndash;1.0564; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.0001). However, the probability of mortality within 30 days of patients consulting at an ER or regional CVD center decreased by 2.66% when compared with that before the establishment of a regional CVD center (estimate\u0026thinsp;=\u0026thinsp;0.9570; 95% CI: 0.9213\u0026ndash;0.9942). Moreover, \u0026beta;2, which revealed the immediate level change after the intervention, decreased; however, this decrease was not significant (estimate\u0026thinsp;=\u0026thinsp;0.7652; 95% CI: 0.4399\u0026ndash;1.3311).\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e presents the sub-cohort analyses stratified using the covariates, including sex, age, insurance type, and income level, correlated with mortality within 30 days of patients consulting at an ER with acute CVD. All remaining covariates other than the ones that were stratified were statistically adjusted to calculate the estimates. Increasing trends in the 30-day mortality pre-intervention that decreased post-intervention were noted in the oldest patients, in addition to patients with work-sponsored insurance, a low decile income level, those without disabilities, and patients who had not undergone PCIs; all values were significant.\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e presents the sub-cohort analyses stratified by mortality occurring within 60 and 90 days of patients consulting at an ER with acute CVD. The probability of mortality within 90 days of patients consulting at an ER with acute CVD significantly decreased (estimate\u0026thinsp;=\u0026thinsp;0.9622; 95% CI: 0.9325\u0026ndash;0.9929). A non-significant decrease in the 60-day mortality was also observed.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we examined how the regional 30-day mortality due to acute CVD had changed based on the time points of pre- and post-establishment (pre- and post-intervention) of regional CVD centers in South Korea. Our results revealed a significant increase in the 30-day mortality during the pre-intervention period. Conversely, a significant decrease in the 30-day mortality during the post-intervention period was observed. An immediate decrease in the effect of policy intervention was observed; however, these values were not significant.\u003c/p\u003e \u003cp\u003e Multiple previous studies have investigated the clinical outcomes of regional CVD centers, and their results align with our findings. Regarding the accessibility of medical care for CVDs, areas with poor medical access have been shown to have worse health outcome-related indicators, compared with areas without appropriate medical access\u003csup\u003e15\u003c/sup\u003e. National research projects have examined the direct effect of the regional specialized CVD centers on mortality rates. Moreover, studies have analyzed the impact of ER arrival time on patient prognosis and ER medical expenses.\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn addition to primary prevention and rehabilitation, creating a well-functioning national healthcare system that ensures the timely and appropriate treatment of patients with acute conditions during the critical early period remains a crucial objective\u003csup\u003e17\u003c/sup\u003e. According to a study by Wang et al., delay in the arrival time is proportionately related to a worse prognosis and greater ER medical expenses.\u003c/p\u003e \u003cp\u003eMoreover, in a study that analyzed the impact of regional emergency medical resources on the mortality rate of older adult patients with ischemic CVD, ample medical resources have been found to decrease the mortality rates.\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Regional Cardiocerebrovascular Center Project for the treatment of acute myocardial infarction revealed shortened door-to-balloon time in patients with ST-segment elevation myocardial infarctions (STEMIs) undergoing primary PCIs.\u003csup\u003e19\u003c/sup\u003e This project supports the media campaign regarding STEMI symptoms, prompt ER consultations, use of ambulances, and patient education.\u003c/p\u003e \u003cp\u003eCooperation between regional emergency centers and CVD centers will improve the survival of patients with acute CVD. Furthermore, many studies have focused on how regional CVD centers can strengthen medical accessibility for patients in remote rural areas. Potential difficulties arise from the disparities in medical accessibility in rural areas.\u003csup\u003e20\u003c/sup\u003e The migration of people from rural areas to cities is the cause of this social dilemma. Thus, the sudden decrease in these rural populations has rendered medical institutions obsolete or non-profitable. However, as most people who have remained in rural areas are patients in need of medical assistance, the government has created policies that could encourage the settling of healthcare personnel and the preservation of medical institutions in rural areas\u003csup\u003e21,22\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite these efforts, particularly regarding the resolution of the accessibility challenge, a concern involving the quality of healthcare remains. Rural areas do not attract the best doctors, and they lack opportunities for career progression\u003csup\u003e23\u003c/sup\u003e. This issue is challenging; however, policymakers must manage and implement strategies that promote the quality of healthcare in rural areas.\u003c/p\u003e \u003cp\u003eMoreover, in their research encompassing eight states of the USA, Probst et al. found that rural residents without access to community health centers are more likely to be hospitalized for conditions and that primary care of acceptable quality can reduce the frequency of these hospitalizations\u003csup\u003e24\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSchroen et al. found that access to medical centers for chronic diseases may drastically reduce surgical interventions, such as mastectomies, where radiotherapy is unavailable.\u003csup\u003e25,26\u003c/sup\u003e Therefore, regional CVD centers increase the accessibility and abundance of medical resources to patients in rural areas, resulting in a higher quality of medical practice and potentially better health outcomes.\u003c/p\u003e \u003cp\u003eThis study has a few limitations, which should be considered when interpreting the results. First, our definitions of CVD relied on ICD-10 codes, which are susceptible to errors, such as miscoding, potentially introducing classification bias. Second, owing to the use of medical claims data, factors such as baseline health status and other health-related variables could not be considered. Nevertheless, the CCI score was adjusted. Variables related to the time spent in the ER and treatment-related variables could have elevated the extent of this analysis. Third, we may have underestimated the target population because patients who had been billed for emergency management fees were included in the analysis. Patients who did not claim emergency management fees may additionally be at risk of acute CVD; thus, further investigations are required. Finally, this study had a retrospective, cross-sectional design; thus, data could potentially have been missing or not recorded.\u003c/p\u003e \u003cp\u003eNotably, despite these limitations, we utilized the NHIS\u0026ndash;NSC database, which offered a substantial and nationally representative sample cohort derived from comprehensive health insurance data. This approach allowed us to address the limitations commonly associated with cross-sectional data, improving the applicability of our findings.\u003c/p\u003e \u003cp\u003eIn conclusion, the findings of this nationwide cohort study suggest that designating regional CVD centers as part of government health policy in rural areas decreases the 30-day CVD-related mortality in patients who consult at ERs. Considering the high mortality rates related to CVD in South Korea, policies to reduce these rates should be further developed and implemented.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would thanks to our colleagues from the Department of Public Health, Graduate School of Yonsei University who provided advice for this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Y.S.J, S.Y.K, E-C P.\u003c/p\u003e\n\u003cp\u003eData curation: Y.S.J, S.Y.K\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFormal analysis: S.Y.J, S.Y/L\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethodology: Y.S.J, S.Y.K, E-C P.\u003c/p\u003e\n\u003cp\u003eWriting - review \u0026amp; editing: Y.S.J, S.Y.K, E-C P.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Korean National Health Insurance Service\u0026ndash;National Sample Cohort is an open-access public database. It comprises health insurance claim data for all Koreans. The sample cohort can be used for public purposes and scientific research, accessible upon approval from the national health insurance service. (https://nhiss.nhis.or.kr/bd/ab/bdaba000eng.do)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. World health statistics 2020. 2020.\u003c/li\u003e\n\u003cli\u003eRossello X, Pocock SJ, Julian DG. Long-term use of cardiovascular drugs: challenges for research and for patient care. 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Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis. bmj 2015;350.\u003c/li\u003e\n\u003cli\u003eThompson SC, Nedkoff L, Katzenellenbogen J, Hussain MA, Sanfilippo F. Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review. Int J Environ Res Public Health 2019;16.\u003c/li\u003e\n\u003cli\u003eKim Y, Lee T-J. Impact of Regional Emergency Medical Access on Patients\u0026rsquo; Prognosis and Emergency Medical Expenditure. Health Policy and Management 2020; 30(3), 399\u0026ndash;408. https://doi.org/10.4332/KJHPA.2020.30.3.399\u003c/li\u003e\n\u003cli\u003eWang JM, Kim BO, Bae JW, Oh DJ. Implementation of National Health Policy for the Prevention and Control of Cardiovascular Disease in South Korea: Regional-Local Cardio-Cerebrovascular Center and Nationwide Registry. Korean Circ J 2021;51:383-98.\u003c/li\u003e\n\u003cli\u003eKo Ej, Cho KJ. Effect of regional emergency medical access on the death rate of elderly individuals with ischemic heart disease. The Korean Journal of Emergency Medical Services 2021; 25(2), 19-38. 10.14408/KJEMS.2021.25.2.019\u003c/li\u003e\n\u003cli\u003eJeong JO. Regional Cardiocerebrovascular Center Project in the Treatment of Acute Myocardial Infarction. The Korean Journal of Medicine\u003c/li\u003e\n\u003cli\u003eWattanasaovaluk K. The economic significance of work experience for elderly employment in Thailand. Journal of Population and Social Studies [JPSS] 2021;29:82-99.\u003c/li\u003e\n\u003cli\u003evan den Heuvel WJ, Olaroiu M. How important are health care expenditures for life expectancy? A comparative, European analysis. Journal of the American Medical Directors Association 2017;18:276. e9-e12.\u003c/li\u003e\n\u003cli\u003eDallmeyer S, Wicker P, Breuer C. How an aging society affects the economic costs of inactivity in Germany: empirical evidence and projections. European review of aging and physical activity 2017;14:1-9.\u003c/li\u003e\n\u003cli\u003eMohammadiaghdam N, Doshmangir L, Babaie J, Khabiri R, Ponnet K. Determining factors in the retention of physicians in rural and underdeveloped areas: a systematic review. BMC Fam Pract 2020;21:216.\u003c/li\u003e\n\u003cli\u003eProbst JC, Laditka JN, Laditka SB. Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states. BMC Health Serv Res 2009;9:134.\u003c/li\u003e\n\u003cli\u003eWeeks WB, Bott DM, Lamkin RP, Wright SM. Veterans Health Administration and Medicare outpatient health care utilization by older rural and urban New England veterans. The Journal of Rural Health 2005;21:167-71.\u003c/li\u003e\n\u003cli\u003eSchroen AT, Brenin DR, Kelly MD, Knaus WA, Slingluff Jr CL. Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients. Journal of clinical oncology 2005;23:7074-80.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cardiovascular disease, emergency room, interrupted time-series analysis, 30-day mortality, regional cardiovascular center","lastPublishedDoi":"10.21203/rs.3.rs-4559463/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4559463/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCardiovascular disease (CVD) remains an important global contributor to mortality and morbidity, with South Korea experiencing higher fatality rates from acute CVD despite excellent hospital care. We investigated regional CVD centers in Korea\u0026rsquo;s impact on CVD-related mortality rates. This population-based cohort study obtained data from the 2002\u0026ndash;2019 Korean National Health Insurance Service\u0026ndash;National Sample Cohort. Eleven of the 15 regional CVD centers were included in the study. For the 2 years pre- and post-establishment of the regional CVD centers, 15,687 patients\u0026rsquo; data were included in the study. The inclusion criteria included (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) having consulted at an emergency room (ER) with the principal diagnosis of acute CVD, including ischemic and hypertensive CVD, and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) residing in the area where the regional CVD center was established during the study cohort period. Patients not meeting these criteria were excluded. The dependent variable, CVD-related mortality, included mortalities occurring within 30, 60, and 90 days of the first consultation at the ER. To analyze the time trend and its change in outcomes, an interrupted time-series analysis with segmented regression was performed. There were 8,009 and 7,678 patients in the pre- and post-intervention cohorts, respectively. The probability of death within 30 days after an ER (or regional CVD center) visit among patients with acute heart disease decreased following the designation of the regional CVD center in that area (estimate, 0.9570; 95% confidence interval, 0.9213\u0026ndash;0.9942). The designation of regional CVD centers, as part of the government health policy, reduces the acute CVD-related 30-day mortality in patients who have consulted at the ER.\u003c/p\u003e","manuscriptTitle":"Impact of Regional Comprehensive Cardiovascular Disease Centers on Mortality in Korea","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-03 18:53:38","doi":"10.21203/rs.3.rs-4559463/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4f98541-c4b3-4650-b40c-e426395a432c","owner":[],"postedDate":"July 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-30T08:24:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-03 18:53:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4559463","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4559463","identity":"rs-4559463","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}