Determinant of Rehospitalization among Tuberculosis Patients: A Recurrent-Event Survival Analysis
DOI:
https://doi.org/10.26911/thejhpm.2026.11.03.03Abstract
Background: Tuberculosis (TB) remains a major public health burden, and recurrent hospitalization signals inefficiency and potential care-quality gaps within Indonesia's National Health Insurance (NHI) scheme. This study analyzed factors affecting the hazard of recurrent hospitalization among TB patients at advanced referral health facilities (RHF).
Subjects and Method: This retrospective cohort study used NHI claims data (2022–2023) for tuberculosis (ICD-10 A15–A19) inpatients at advanced RHFs across Indonesia, selected through purposive sampling. From an initial 26,740 hospitalization episodes, screening for data completeness, INA-CBGs case groups, and ICD-10 TB diagnosis criteria yielded 1,574 recurrent hospitalization episodes from 1,202 eligible patients. The dependent variable was time to recurrent hospitalization with its event indicator. Independent variables were disease severity, TB type, NHI participant segment, length of stay, regional area, and referral hospital type. Data were analyzed using Kaplan–Meier estimation, the log-rank test, and the Andersen–Gill recurrent-event survival model in Stata 17.0.
Results: The 1,202 patients contributed 1,574 hospitalization episodes; 271 (22.55%) experienced at least one recurrent hospitalization. In bivariate analysis, patients in Regional 2 (HR= 1.55; 95% CI= 1.158 to 2.08; p= 0.003) and Regional 5 (HR= 1.54; 95% CI= 1.146 to 2.07; p= 0.004) had significantly higher hazard than those in Regional 1. After adjustment, both associations attenuated but remained significant (Regional 2: aHR= 1.54; p= 0.006; Regional 5: aHR= 1.44; p= 0.008). Hospital type, particularly Women and Children's Hospital, showed marginal significance (aHR= 1.7; p= 0.07). Disease severity, TB type, participant segment, and length of stay were not significantly associated with recurrent hospitalization.
Conclusion: Regional area is the strongest factor associated with recurrent hospitalization among TB patients at referral facilities, reflecting geographic disparities in referral care. These findings may inform NHI policy in strengthening the tiered referral system and equalizing service capacity and quality across regions.
Keywords:
recurrent hospitalization, tuberculosis, survival analysis, referral facility, health insuranceHow to Cite
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