Association between insurance status and in-hospital outcomes in patients with out-of-hospital ventricular fibrillation arrest.
mortality
uninsured
ventricular fibrillation
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
04
09
2020
accepted:
01
12
2020
pubmed:
5
3
2021
medline:
16
10
2021
entrez:
4
3
2021
Statut:
ppublish
Résumé
Lack of health insurance is associated with adverse clinical outcomes; however, the association between health insurance status and in-hospital outcomes after out-of-hospital ventricular fibrillation (OHVFA) arrest is unclear. Lack of health insurance is associated with worse in-hospital outcomes after out-of-hospital ventricular fibrillation arrest. From January 2003 to December 2014, hospitalizations with a primary diagnosis of OHVFA in patients ≥18 years of age were extracted from the Nationwide Inpatient Sample. Patients were categorized into insured and uninsured groups based on their documented health insurance status. Study outcome measures were in-hospital mortality, utilization of implantable cardioverter defibrillator (ICD), and cost of hospitalization. Inverse probability weighting adjusted binary logistic regression was performed to identify independent predictors of in-hospital mortality and ICD utilization and linear regression was performed to identify independent predictors of cost of hospitalization. Of 188 946 patients included in the final analyses, 178 005 (94.2%) patients were insured and 10 941 (5.8%) patients were uninsured. Unadjusted in-hospital mortality was higher (61.7% vs. 54.7%, p < .001) and ICD utilization was lower (15.3% vs. 18.3%, p < .001) in the uninsured patients. Lack of health insurance was independently associated with higher in-hospital mortality (O.R = 1.53, 95% C.I. [1.46-1.61]; p < .001) and lower utilization of ICD (O.R = 0.84, 95% C.I [0.79-0.90], p < .001). Cost of hospitalization was significantly higher in uninsured patients (median [interquartile range], p-value) ($) (39 650 [18 034-93 399] vs. 35 965 [14 568.50-96 163], p < .001). Lack of health insurance is associated with higher in-hospital mortality, lower utilization of ICD and higher cost of hospitalization after OHVFA.
Sections du résumé
BACKGROUND
BACKGROUND
Lack of health insurance is associated with adverse clinical outcomes; however, the association between health insurance status and in-hospital outcomes after out-of-hospital ventricular fibrillation (OHVFA) arrest is unclear.
HYPOTHESIS
OBJECTIVE
Lack of health insurance is associated with worse in-hospital outcomes after out-of-hospital ventricular fibrillation arrest.
METHODS
METHODS
From January 2003 to December 2014, hospitalizations with a primary diagnosis of OHVFA in patients ≥18 years of age were extracted from the Nationwide Inpatient Sample. Patients were categorized into insured and uninsured groups based on their documented health insurance status. Study outcome measures were in-hospital mortality, utilization of implantable cardioverter defibrillator (ICD), and cost of hospitalization. Inverse probability weighting adjusted binary logistic regression was performed to identify independent predictors of in-hospital mortality and ICD utilization and linear regression was performed to identify independent predictors of cost of hospitalization.
RESULTS
RESULTS
Of 188 946 patients included in the final analyses, 178 005 (94.2%) patients were insured and 10 941 (5.8%) patients were uninsured. Unadjusted in-hospital mortality was higher (61.7% vs. 54.7%, p < .001) and ICD utilization was lower (15.3% vs. 18.3%, p < .001) in the uninsured patients. Lack of health insurance was independently associated with higher in-hospital mortality (O.R = 1.53, 95% C.I. [1.46-1.61]; p < .001) and lower utilization of ICD (O.R = 0.84, 95% C.I [0.79-0.90], p < .001). Cost of hospitalization was significantly higher in uninsured patients (median [interquartile range], p-value) ($) (39 650 [18 034-93 399] vs. 35 965 [14 568.50-96 163], p < .001).
CONCLUSION
CONCLUSIONS
Lack of health insurance is associated with higher in-hospital mortality, lower utilization of ICD and higher cost of hospitalization after OHVFA.
Identifiants
pubmed: 33660870
doi: 10.1002/clc.23564
pmc: PMC8027577
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
511-517Informations de copyright
© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
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