Survival Analysis of Stroke Incidence in National Health Insurance Participants from 2015 – 2020
Abstract
This study aims to analyze the survival of stroke patients enrolled in the National Health Insurance (Jaminan Kesehatan Nasional, JKN) program and factors affecting it during the 2015–2020 period. Survival analysis was utilized using the Kaplan-Meier estimator and the Cox Proportional Hazards model. The dataset consisted of 12,773 stroke patients sampled from BPJS Kesehatan administrative records. The results indicate that since being registered as BPJS Kesehatan participants or from the baseline year 2015, stroke patients had an average survival time of 2,264 days, with a 95% confidence interval between 2,240 and 2,287 days. The Cox model revealed that patients aged 18–35, 36–50, 51–65, and >65 had Hazard Ratios (HR) of 1.30, 1.69, 2.47, and 3.52, respectively. Female patients exhibited a lower risk of death (HR = 0.81) than males. Employment segment effects were modest, and regional disparities were observed, with the Eastern region showing a higher risk (HR = 1.29). Comorbidities further increased hazards, with hypertension (HR = 1.70) and diabetes (HR = 2.17) significantly raising mortality risk. As one of the first large-scale survival analyses using JKN national data, this study offers novel evidence on key determinants of stroke outcomes in Indonesia. Its findings highlight critical risk factors and support more targeted, data-driven strategies for stroke prevention under universal health coverage.
Keywords: Cox Proportional Hazard; Kaplan-Meier; National Health Insurance Agency; Stroke; Survival Analysis.
Abstrak
Penelitian ini bertujuan untuk menganalisis survival pasien stroke yang terdaftar dalam program Jaminan Kesehatan Nasional (JKN) dan faktor-faktor yang memengaruhinya selama periode 2015–2020. Metode yang digunakan adalah analisis survival dengan pendekatan Kaplan-Meier dan model Cox Proportional Hazards. Data yang dianalisis diambil dari sampel BPJS Kesehatan peserta JKN selama 2015–2020, yang berjumlah 12.773 pasien. Hasil penelitian menunjukkan bahwa sejak terdaftar sebagai peserta BPJS Kesehatan atau sejak tahun dasar 2015, pasien stroke memiliki waktu survival rata-rata 2.264 hari, dengan interval kepercayaan 95% antara 2.240 dan 2.287 hari. Model Cox mengungkapkan pasien berusia 18–35, 36–50, 51–65, dan >65 memiliki HR masing-masing sebesar 1,30, 1,69, 2,47, dan 3,52. Perempuan memiliki risiko lebih rendah (HR = 0,81) dibandingkan laki-laki. Efek pada segmen pekerjaan relatif kecil, dan disparitas regional teramati, dengan wilayah Timur menunjukkan risiko yang lebih tinggi (HR = 1,29). Komorbiditas semakin meningkatkan risiko, dengan hipertensi (HR = 1,70) dan diabetes (HR = 2,17) secara signifikan meningkatkan risiko mortalitas. Sebagai salah satu analisis survival skala besar pertama yang menggunakan data nasional JKN, studi ini menawarkan bukti baru tentang determinan utama luaran stroke di Indonesia. Temuannya menyoroti faktor risiko kritis dan mendukung strategi pencegahan stroke yang lebih terarah dan berbasis data dalam kerangka jaminan kesehatan semesta.
Kata Kunci: Cox Proportional Hazard; Kaplan-Meier; Jaminan Kesehatan Nasional; Stroke; Analisis survival.
2020MSC: 91G05.
Keywords
References
S. J. X. Murphy and D. J. Werring, "Stroke: causes and clinical features," Medicine, vol. 48, no. 9, pp. 561–566, 2020.
V. L. Feigin, M. Brainin, B. Norrving, S. O. Martins, J. Pandian, P. Lindsay, M. F. Grupper, and I. Rautalin, "World stroke organization: global stroke fact sheet 2025," Int. J. Stroke, vol. 20, no. 2, pp. 132–144, 2025.
GBD 2019 Stroke Collaborators, "Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019," Lancet Neurol, vol. 20, no. 10, pp. 795–820, Oct. 2021, doi: 10.1016/S1474-4422(21)00252-0.
Statistics Indonesia (BPS), "Vital Statistics Report 2019–2023." [Online]. Available: https://www.bps.go.id/. [Accessed: Jul. 10, 2025].
T. Yahya et al., "Stroke in young adults: Current trends, opportunities for prevention and pathways forward," Am. J. Prev. Cardiol, vol. 3, p. 100085, 2020.
BPJS Kesehatan, "JKN Statistics 2015–2020." [Online]. Available: https://www.bpjs-kesehatan.go.id/. [Accessed: Jul. 20, 2025].
Statistics Indonesia (BPS), "Number of National Health Insurance (JKN) Participants by Category, 2014–2020." [Online]. Available: https://www.bps.go.id/statictable/2015/12/21/1953/. [Accessed: Feb. 18, 2025].
D. Lestari, "Epidemiologi penyakit kardiovaskular di Indonesia," J. Kesehatan Masyarakat, vol. 15, no. 1, pp. 32–45, 2020.
T. Qomaria, M. Fatekurohman, and D. Anggraeni, "Aplikasi model Cox Proportional Hazard pada pasien stroke RSD Balung Kabupaten Jember," Indonesian J. Appl. Stat., vol. 2, no. 2, pp. 94–112, 2019.
D. R. Cox, "Regression Models and Life-Tables," J. R. Stat. Soc. Ser. B, vol. 34, no. 2, pp. 187–220, 1972.
B. W. Negasa, T. W. Wotale, M. E. Lelisho, L. K. Debusho, K. Sisay, and W. Gezimu, "Modeling survival time to death among stroke patients at Jimma University Medical Center, Southwest Ethiopia: A retrospective cohort study," Stroke Res. Treat., vol. 2023, no. 1, p. 1557133, 2023.
V. A. J. M. Silalahi, "Ten Year Evaluation of JKN: Strengthening Primary Health Care for National Resilience," Indonesian Journal of Economic & Management Sciences, vol. 2, no. 4, pp. 651–670, 2024, doi: 10.55927/ijems.v2i4.10761.
R. L. Chen, J. Balami, M. Esiri et al., "Ischemic stroke in the elderly: an overview of evidence," Nat. Rev. Neurol., vol. 6, pp. 256–265, 2010, doi: 10.1038/nrneurol.2010.36.
D. D. Kharisma, "Healthcare Access Inequity within a Social Health Insurance Setting: A Risk Faced by Indonesia’s Jaminan Kesehatan Nasional (JKN) Program," BWP, vol. 3, no. 1, pp. 63–74, Mar. 2020.
"Inequities in neurological care: Access to services, care gaps, and other barriers—A systematic review," Eur. J. Neurol., p. e16553, Nov. 2024, doi: 10.1111/ene.16553.
M. P. McGinley, T. Harvey, R. Lopez, D. Ontaneda, and R. B. Buchalter, "Geographic Disparities in Access to Neurologists and Multiple Sclerosis Care in the United States," Neurology, vol. 102, no. 2, 2024.
A. Fornari, M. Lanza, E. Guastafierro et al., "Inequities in neurological care: Access to services, care gaps, and other barriers—A systematic review," Eur. J. Neurol., vol. 32, p. e16553, 2025, doi: 10.1111/ene.16553.
S. A. ElHafeez, C. Torino, G. D’Arrigo et al., "An overview on standard statistical methods for assessing exposure-outcome link in survival analysis (Part II): the Kaplan-Meier analysis and the Cox regression method," Aging Clin. Exp. Res., vol. 24, pp. 203–206, 2012, doi: 10.1007/BF03325249.
A. W. Kassie, "Determinants of survival in stroke patients: application of Cox proportional hazards regression model," preprint, Research Square, Nov. 2022. [Online]. Available: https://doi.org/10.21203/rs.3.rs-2206159/v1.
M. G. McCandless, A. Y. Powers, K. E. Baker, and A. E. Strickland, "Trends in Demographic and Geographic Disparities in Stroke Mortality Among Older Adults in the United States," World Neurosurg., vol. 185, pp. e620–e630, 2024.
M. G. McCandless, A. Y. Powers, K. E. Baker, and A. E. Strickland, "Trends in Demographic and Geographic Disparities in Stroke Mortality Among Older Adults in the United States," World Neurosurg., Feb. 2024, doi: 10.1016/j.wneu.2024.02.094.
DOI: 10.15408/inprime.v7i2.49104
Refbacks
- There are currently no refbacks.
.
