Document Detail

Insurance type influences the use of drug-eluting stents.
MedLine Citation:
PMID:  20650440     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We sought to examine the effect of insurance type upon the likelihood of receiving a drug-eluting stent (DES).
BACKGROUND: Recent guidelines suggest that consideration of a patient's resources should play a role in decisions to use DES. Previous studies have also documented disparities in both access to care and cardiovascular outcomes according to race, insurance, and socioeconomic status. The effect of insurance status upon the decision to use DES is unclear.
METHODS: Patients undergoing percutaneous coronary intervention (PCI) with stenting from April 2003 to June 2009, the so-called DES era, were retrospectively analyzed. Multivariable logistic regression was performed separately for patients <65 years and patients > or =65 years, with receipt of > or =1 DES during PCI as the outcome variable of interest. Insurance type was categorized as private, Medicare, Medicaid, and uninsured, based upon the primary insurance at discharge. Data regarding duration of clopidogrel therapy at 1 month, 6 months, and 1 year was also collected.
RESULTS: Among the 12,584 patients who underwent PCI with stenting, 6,157 (48.9%) had private insurance, 5,689 (45.2%) had Medicare, 467 (3.7%) had Medicaid, and 271 (2.2%) were uninsured at the time of hospital discharge. There were no significant differences by insurance type in duration of dual antiplatelet therapy at 1 year. Both multivariable logistic regressions showed that Medicaid patients (odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.46 to 0.78 for age <65 years; OR: 0.45; 95% CI: 0.24 to 0.85 for age > or =65 years) and patients without insurance (OR: 0.57; 95% CI: 0.42 to 0.78 for age <65 years; OR: 0.20; 95% CI: 0.05 to 0.86 for age > or =65 years) were less likely to receive DES.
CONCLUSIONS: Insurance status has a significant impact upon the decision to use DES. Efforts to address this disparity should focus on the patient-provider level.
Michael A Gaglia; Rebecca Torguson; Zhenyi Xue; Manuel A Gonzalez; Sara D Collins; Itsik Ben-Dor; Asmir I Syed; Gabriel Maluenda; Cedric Delhaye; Nicholas Hanna; Kohei Wakabayashi; Kimberly Kaneshige; William O Suddath; Kenneth M Kent; Lowell F Satler; Augusto D Pichard; Ron Waksman
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  3     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-23     Completed Date:  2010-11-08     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  773-9     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Angioplasty, Balloon, Coronary / economics*,  instrumentation
District of Columbia
Drug Costs
Drug-Eluting Stents / economics*
Health Care Costs*
Health Services Accessibility / economics
Healthcare Disparities / economics
Insurance, Health / economics*
Logistic Models
Medicaid / economics*
Medicare / economics*
Middle Aged
Odds Ratio
Patient Selection*
Platelet Aggregation Inhibitors / economics
Private Sector / economics*
Retrospective Studies
Risk Assessment
Risk Factors
United States
Reg. No./Substance:
0/Platelet Aggregation Inhibitors
Comment In:
JACC Cardiovasc Interv. 2010 Jul;3(7):780-2   [PMID:  20650441 ]

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