| Insurance status predicts access to care and outcomes of vascular disease. | |
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MedLine Citation:
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PMID: 18586449 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine if insurance status predicts severity of vascular disease at the time of treatment or outcomes following intervention. METHODS: Hospital discharge databases from Florida and New York from 2000-2005 were analyzed for lower extremity revascularization (LER, n = 73,532), carotid revascularization (CR, n = 116,578), or abdominal aortic aneurysm repair (AAA, n = 35,593), using ICD-9 codes for diagnosis and procedure. The indications for intervention as well as the post-operative outcomes were examined assigning insurance status as the independent variable. Patients covered under a variety of commercial insurers, as well as Medicare, were compared to those who either had no insurance or were covered by Medicaid. RESULTS: Patients without insurance or with Medicaid were at significantly greater risk of presenting with a ruptured AAA compared to insured (non-Medicaid) patients; while insurance status did not seem to impact post-operative mortality rates for elective and ruptured AAA repair. The uninsured or Medicaid recipients presented with symptomatic carotid disease nearly twice as often as the insured, but stroke rates after CR did not differ significantly based on insurance status. Patients with Medicaid or without insurance were more likely to present with limb threatening ischemia than claudication. In contrast to AAA repair and CR, the outcomes of LER were worse in the uninsured and Medicaid beneficiaries who had higher rates of post-revascularization amputation compared to the insured (non-Medicaid) group. CONCLUSION: Insurance status predicts disease severity at the time of treatment, but once treated, the outcomes are similar among insurance categories, with the exception of lower extremity revascularization. This data suggests inferior access to preventative vascular care in the Medicaid and the uninsured populations. |
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Authors:
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Jeannine K Giacovelli; Natalia Egorova; Roman Nowygrod; Annetine Gelijns; K Craig Kent; Nicholas J Morrissey |
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Publication Detail:
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Type: Journal Article Date: 2008-06-30 |
Journal Detail:
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Title: Journal of vascular surgery Volume: 48 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-11-10 Completed Date: 2008-12-04 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 905-11 Citation Subset: IM |
Affiliation:
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Division of Vascular Surgery, New York Presbyterian Hospital, Columbia College of Physicians and Surgeons, Weill Medical College of Cornell University, New York, NY, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aortic Aneurysm, Abdominal / surgery* Arterial Occlusive Diseases / surgery* Carotid Stenosis / surgery* Female Health Services Accessibility / statistics & numerical data Humans Insurance, Health* Leg / blood supply Male Middle Aged Prognosis Severity of Illness Index Treatment Outcome United States Vascular Surgical Procedures / statistics & numerical data |
| Grant Support | |
ID/Acronym/Agency:
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L60 MD002558-01/MD/NIMHD NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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