Document Detail


Insurance status, not race, is associated with mortality after an acute cardiovascular event in Maryland.
MedLine Citation:
PMID:  22821570     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: It is unclear how lack of health insurance or otherwise being underinsured contributes to observed racial disparities in health outcomes related to cardiovascular disease.
OBJECTIVE: To determine the relative risk of death associated with insurance and race after hospital admission for an acute cardiovascular event.
DESIGN: Prospective cohort study in three hospitals in Maryland representing different demographics between 1993 and 2007.
PATIENTS: Patients with an incident admission who were either white or black, and had either private insurance, state-based insurance or were uninsured. 4,908 patients were diagnosed with acute myocardial infarction, 6,759 with coronary atherosclerosis, and 1,293 with stroke.
MAIN MEASURES: Demographic and clinical patient-level data were collected from an administrative billing database and neighborhood household income was collected from the 2000 US Census. The outcome of all-cause mortality was collected from the Social Security Death Master File.
KEY RESULTS: In an analysis adjusted for race, disease severity, location, neighborhood household income among other confounders, being underinsured was associated with an increased risk of death after myocardial infarction (relative hazard, 1.31 [95 % CI: 1.09, 1.59]), coronary atherosclerosis (relative hazard, 1.50 [95 % CI: 1.26, 1.80]) or stroke (relative hazard, 1.25 [95 % CI: 0.91, 1.72]). Black race was not associated with an increased risk of death after myocardial infarction (relative hazard, 1.03 [95 % CI: 0.85, 1.24]), or after stroke (relative hazard, 1.18 [95 % CI: 0.86, 1.61]) and was associated with a decreased risk of death after coronary atherosclerosis (relative hazard, 0.82 [95 % CI: 0.69, 0.98]).
CONCLUSIONS: Race was not associated with an increased risk of death, before or after adjustment. Being underinsured was strongly associated with death among those admitted with myocardial infarction, or a coronary atherosclerosis event. Our results support growing evidence implicating insurance status and socioeconomic factors as important drivers of health disparities, and potentially racial disparities.
Authors:
Derek K Ng; Daniel J Brotman; Bryan Lau; J Hunter Young
Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Journal of general internal medicine     Volume:  27     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-19     Completed Date:  2013-07-11     Revised Date:  2013-10-10    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1368-76     Citation Subset:  IM    
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E7133, Baltimore, MD 21025, USA. dng@jhsph.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Continental Population Groups* / ethnology
Coronary Artery Disease / economics*,  ethnology,  mortality
Female
Humans
Insurance Coverage / economics*,  trends
Male
Maryland / ethnology
Middle Aged
Myocardial Infarction / economics*,  ethnology,  mortality
Prospective Studies
Stroke / economics*,  ethnology,  mortality
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