JHM: Uninsured patients have 50% greater chance of dying of MI, stroke

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Nearly one in five working-age Americans (age 18-64) is uninsured. And, for those hospitalized for acute MI, stroke or pneumonia, researchers found that rates of mortality, length of stay and cost per hospitalization differed and mortality rates were sometimes higher in the uninsured and Medicare populations compared to those with private insurance, according to a study published June 10 in the Journal of Hospital Medicine.

“To our knowledge, no nationally representative study has focused on the impact of insurance coverage on hospital care for common medical conditions among working-age Americans, the fastest growing segment of the uninsured population,” the authors wrote.

Because most prior studies focused on the outpatient setting, Omar Hasan, MBBS, of Brigham and Women’s Hospital in Boston, and colleagues evaluated hospitalized patients who were discharged from 1,018 hospitals in 37 states.

Data for the study were drawn from the 2005 Nationwide Inpatient Sample (NIS), which is  maintained by the Agency for Healthcare Research and Quality (AHRQ).

In total, the cohort was representative of 755,346 working-age U.S. patients, who had 225,947 cases of acute MI (AMI), 151,812 cases of stroke and 377,588 cases of pneumonia. Of these patients, 47.5 percent held private insurance, 23 percent received Medicare, 17 percent received Medicaid and 12 percent were uninsured.

More patients who were uninsured or on Medicaid were younger, less likely white, had lower incomes and were more likely admitted to the emergency department.

Of the 154,381 patients identified by the researchers for evaluation, 36.7 percent of the privately insured had AMI and 31.2 percent of patients with AMI were uninsured and 19.7 percent on Medicaid. Similarly, for stroke these numbers were 20.6, 23.7 and 19.9 percent, respectively. The highest rates were for pneumonia at 42.7, 45.2 and 60.4 percent, respectively.

According to the researchers, cancer, MI, stroke and pneumonia are the leading causes of death for patients under age 65.

The researchers also found that mortality rates were highest in patients who were both uninsured and on Medicaid compared to those who held private insurance.

When the authors standardized for age and sex, results showed that in-hospital mortality for AMI and stroke was higher for the uninsured and Medicaid patients while Medicaid beneficiaries had higher in-hospital pneumonia compared with those who were privately insured.

"Compared with the privately insured, hospital mortality among AMI and stroke patients was significantly higher for the uninsured, 52 percent and 49 percent, respectively, and 21 percent higher among Medicaid recipients with pneumonia," the authors wrote.

Additionally, results showed that length of stay for uninsured and Medicaid AMI and stroke patients was lower than those who held private insurance. For pneumonia patients, those who were uninsured had shorter average length of stay compared to the privately insured.

The researchers also looked at costs of hospitalizations between the privately insured, the uninsured and those on Medicaid. Results showed that Medicaid patients had the highest costs followed by the privately insured and the uninsured.

These costs for stroke were $18,462, $16,022 and $14,571, respectively, and $9,479, $8,223 and $7,086 for pneumonia.

“We found that insurance status was associated with significant variations in in-hospital mortality and resource use,” the authors wrote. “In light of the current economic recession and national healthcare debate, these findings may be a prescient indication of a widening insurance gap in the quality of hospital care.”

The authors said that disparities within the data may be due to the fact that the study did not look at the severity of the three conditions in regard to insurance status. The researchers offered that the uninsured tend to present with more severe illnesses at the time of admission due to delaying care because of lack of coverage.

To conclude the researchers said that policy makers, physicians and hospital staff should be aware of these insurance disparities and take steps to close the gap in care. Additionally, they wrote that “further studies are needed to determine whether provider sensitivity to insurance status or unmeasured sociodemographic and clinical prognostic factors are responsible for these disparities.”