Clinical InvestigationInterventional CardiologyAssociation of health insurance status with presentation and outcomes of coronary artery disease among nonelderly adults undergoing percutaneous coronary intervention
Section snippets
Study design
Data were collected from all patients who underwent PCI between January 1, 2004, and December 31, 2007, at 4 New York State academic medical centers. Data elements included patient demographic information; insurance status; baseline clinical, angiographic, and procedural characteristics; as well as in-hospital outcomes. To protect the anonymity of patients, all data were stripped of 20 potential identifiers by each individual center and submitted to a central databank for analysis. The
Results
Among 13,456 patients analyzed, 11,927 (88.6%) were covered by private insurance, 1,036 (7.7%) were covered by Medicaid, and 493 (3.7%) were designated as uninsured. Of the privately insured patients, 6,468 (54.2%) were enrolled in fee-for-service plans, whereas 5,429 (45.8%) were covered by managed care plans, and 646 (62.4%) and 390 (37.6%) of the Medicaid-insured patients were covered by fee-for service and managed care plans, respectively. Baseline demographic data and medical history are
Comment
The significant findings of this retrospective cohort study in which all patients underwent PCI for CAD are 2-fold. First, uninsured and Medicaid patients present more often at a younger age, with an acute coronary syndrome, with more advanced CAD for age, and with a greater degree of left ventricular dysfunction than do patients with private insurance. Second, after multivariable risk adjustment, lack of insurance and Medicaid coverage are both independently associated with an increased risk
Conclusions
In this observational analysis, uninsured or Medicaid insurance status was independently associated with a 3- to 4-fold increased risk of in-hospital mortality in patients undergoing PCI for CAD. Clinical outcomes may be improved by eliminating financial barriers and ensuring unimpeded access to outpatient health care for uninsured and underinsured individuals.
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2021, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :The question remains whether insurance status has further impact on outcomes after the delivery of IAT. For instance, uninsured or Medicaid patients undergoing coronary reperfusion treatments are more likely to suffer in-hospital death as a result of more advanced chronic medical conditions.9 We use a multistate stroke registry to examine the effect of insurance status on outcomes for AIS patients who receive IAT.
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