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Association Between Health Insurance Status and In-Hospital Outcomes After ST-Segment Elevation Myocardial Infarction.
Am J Cardiol. 2017 Oct 01; 120(7):1049-1054.AJ

Abstract

Lack of health insurance is associated with adverse clinical outcomes; however, association between health insurance status and outcomes in patients presenting with ST-elevation myocardial infarction (STEMI) is unclear. Using the Nationwide Inpatient Sample data from 2003 to 2014, hospitalizations with STEMI in patients 18 years of age and older were extracted. Based on health insurance status, patients were categorized into insured and uninsured groups. The primary outcome measure was in-hospital mortality. Adjusted analysis using inverse probability weighting with multivariable regression was performed to identify independent predictors of in-hospital mortality. Of 2,710,375 patients included in the final analysis, 220,770 patients were uninsured. Unadjusted in-hospital mortality was lower in uninsured patients (5.1% vs 9.3%; p <0.001). Adjusted analysis showed that lack of health insurance was associated with the worst in-hospital mortality (odds ratio [OR] = 1.77, 95% confidence interval [CI] 1.72 to 1.82; p <0.001). Other independent predictors of in-hospital mortality were low household income (OR = 1.08, 95% CI 1.07 to 1.09; p <0.001), acute stroke (OR = 2.87, 95% CI 2.80 to 2.95; p <0.001), acute kidney injury (OR = 2.60, 95% CI 2.57 to 2.64; p <0.001), cardiac arrest (OR = 8.88, 95% CI 8.77 to 8.99; p <0.001), cardiogenic shock (OR = 5.81, 95% CI 5.74 to 5.88; p <0.001), requirement of pericardiocentesis (OR = 10.54, 95% CI 9.64 to 11.52; p <0.001), gastrointestinal bleeding (OR = 1.41, 95% CI 1.38 to 1.54; p <0.001), and pneumonia (OR = 1.43, 95% CI 1.41 to 1.45; p <0.001). The multivariate model demonstrated good statistical discrimination (c-statistic = 0.89). In conclusion, lack of health insurance is independently associated with increased in-hospital mortality in patients presenting with STEMI.

Authors+Show Affiliations

Division of Cardiology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania. Electronic address: pancholy8@gmail.com.Division of Cardiology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania.Division of Cardiology, Jefferson Medical College, Philadelphia, Pennsylvania.Division of Cardiology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania.Division of Cardiology, New York University Medical Center, New York, New York.Division of Cardiology, Beth Israel Medical Center, New York, New York.Division of Cardiology, Apex Heart Institute, Ahmedabad, India.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28823480

Citation

Pancholy, Samir, et al. "Association Between Health Insurance Status and In-Hospital Outcomes After ST-Segment Elevation Myocardial Infarction." The American Journal of Cardiology, vol. 120, no. 7, 2017, pp. 1049-1054.
Pancholy S, Patel G, Pancholy M, et al. Association Between Health Insurance Status and In-Hospital Outcomes After ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2017;120(7):1049-1054.
Pancholy, S., Patel, G., Pancholy, M., Nanavaty, S., Coppola, J., Kwan, T., & Patel, T. (2017). Association Between Health Insurance Status and In-Hospital Outcomes After ST-Segment Elevation Myocardial Infarction. The American Journal of Cardiology, 120(7), 1049-1054. https://doi.org/10.1016/j.amjcard.2017.06.041
Pancholy S, et al. Association Between Health Insurance Status and In-Hospital Outcomes After ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2017 Oct 1;120(7):1049-1054. PubMed PMID: 28823480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Health Insurance Status and In-Hospital Outcomes After ST-Segment Elevation Myocardial Infarction. AU - Pancholy,Samir, AU - Patel,Gaurav, AU - Pancholy,Maitri, AU - Nanavaty,Sukrut, AU - Coppola,John, AU - Kwan,Tak, AU - Patel,Tejas, Y1 - 2017/07/17/ PY - 2017/03/08/received PY - 2017/06/08/revised PY - 2017/06/28/accepted PY - 2017/8/22/pubmed PY - 2017/9/15/medline PY - 2017/8/22/entrez SP - 1049 EP - 1054 JF - The American journal of cardiology JO - Am J Cardiol VL - 120 IS - 7 N2 - Lack of health insurance is associated with adverse clinical outcomes; however, association between health insurance status and outcomes in patients presenting with ST-elevation myocardial infarction (STEMI) is unclear. Using the Nationwide Inpatient Sample data from 2003 to 2014, hospitalizations with STEMI in patients 18 years of age and older were extracted. Based on health insurance status, patients were categorized into insured and uninsured groups. The primary outcome measure was in-hospital mortality. Adjusted analysis using inverse probability weighting with multivariable regression was performed to identify independent predictors of in-hospital mortality. Of 2,710,375 patients included in the final analysis, 220,770 patients were uninsured. Unadjusted in-hospital mortality was lower in uninsured patients (5.1% vs 9.3%; p <0.001). Adjusted analysis showed that lack of health insurance was associated with the worst in-hospital mortality (odds ratio [OR] = 1.77, 95% confidence interval [CI] 1.72 to 1.82; p <0.001). Other independent predictors of in-hospital mortality were low household income (OR = 1.08, 95% CI 1.07 to 1.09; p <0.001), acute stroke (OR = 2.87, 95% CI 2.80 to 2.95; p <0.001), acute kidney injury (OR = 2.60, 95% CI 2.57 to 2.64; p <0.001), cardiac arrest (OR = 8.88, 95% CI 8.77 to 8.99; p <0.001), cardiogenic shock (OR = 5.81, 95% CI 5.74 to 5.88; p <0.001), requirement of pericardiocentesis (OR = 10.54, 95% CI 9.64 to 11.52; p <0.001), gastrointestinal bleeding (OR = 1.41, 95% CI 1.38 to 1.54; p <0.001), and pneumonia (OR = 1.43, 95% CI 1.41 to 1.45; p <0.001). The multivariate model demonstrated good statistical discrimination (c-statistic = 0.89). In conclusion, lack of health insurance is independently associated with increased in-hospital mortality in patients presenting with STEMI. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/28823480/Association_Between_Health_Insurance_Status_and_In_Hospital_Outcomes_After_ST_Segment_Elevation_Myocardial_Infarction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(17)31103-7 DB - PRIME DP - Unbound Medicine ER -