| Considering health insurance: how do dialysis initiates with Medicaid coverage differ from persons without Medicaid coverage? | |
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MedLine Citation:
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PMID: 19736241 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Type of health insurance is an important mediator of medical outcomes in the United States. Medicaid, a jointly sponsored Federal/State programme, is designed to serve medically needy individuals. How these patients differ from non-Medicaid-enrolled incident dialysis patients and how these differences have changed over time have not been systematically examined. METHODS: Using data from the United States Renal Data System, we identified individuals initiating dialysis from 1995 to 2004 and categorized their health insurance status. Longitudinal trends in demographic, risk behaviour, functional, comorbidity, laboratory and dialysis modality factors, as reported on the Medical Evidence Form (CMS-2728), were examined in all insurance groups. Polychotomous logistic regression was used to estimate adjusted generalized ratios (AGRs) for these factors by insurance status, with Medicaid as the referent insurance group. RESULTS: Overall, males constitute a growing percentage of both Medicaid and non-Medicaid patients, but in contrast to other insurance groups, Medicaid has a higher proportion of females. Non-Caucasians also constitute a higher proportion of Medicaid patients than non-Medicaid patients. Body mass index increased in all groups over time, and all groups witnessed a significant decrease in initiation on peritoneal dialysis. Polychotomous regression showed generally lower AGRs for minorities, risk behaviours and functional status, and higher AGRs for males, employment and self-care dialysis, for non-Medicaid insurance relative to Medicaid. CONCLUSIONS: While many broad parallel trends are evident in both Medicaid and non-Medicaid incident dialysis patients, many important differences between these groups exist. These findings could have important implications for policy planners, providers and payers. |
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Authors:
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James B Wetmore; Sally K Rigler; Jonathan D Mahnken; Purna Mukhopadhyay; Theresa I Shireman |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2009-09-07 |
Journal Detail:
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Title: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Volume: 25 ISSN: 1460-2385 ISO Abbreviation: Nephrol. Dial. Transplant. Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2009-12-23 Completed Date: 2010-03-18 Revised Date: 2011-12-15 |
Medline Journal Info:
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Nlm Unique ID: 8706402 Medline TA: Nephrol Dial Transplant Country: England |
Other Details:
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Languages: eng Pagination: 198-205 Citation Subset: IM |
Affiliation:
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Division of Nephrology and Hypertension, Department of Medicine, University of Kansas School of Medicine, KS, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Comorbidity Female Humans Insurance, Health / economics*, trends Kidney Failure, Chronic / economics, therapy* Logistic Models Longitudinal Studies Male Medicaid / economics*, trends Middle Aged Renal Dialysis / economics*, trends Retrospective Studies Risk-Taking United States |
| Grant Support | |
ID/Acronym/Agency:
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1R01DK080111-01/DK/NIDDK NIH HHS; K23 DK085378-03/DK/NIDDK NIH HHS; R01 DK080111-01A1/DK/NIDDK NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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