Insurance status affects survival after cardiac event

By Sarah Guy, MedWire Reporter

Patients admitted to hospital with an acute cardiac event have higher rates of mortality if they are underinsured compared with those who have private insurance, show US study results.

The association was independent of race and other patient-related confounders, and "underscores the need to closely investigate the factors relating to health insurance that may explain these disparities," say the researchers.

"Indeed, targeting these factors may relieve the burden of mortality disproportionately affecting those who are underinsured," add Derek Ng (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland) and colleagues in the Journal of General Internal Medicine.

Their review of data from three Maryland hospitals for patients admitted with acute myocardial infarction (MI), coronary atherosclerosis, or strokes showed that the proportion of subjects who were underinsured was much lower than those with private insurance, ranging from 11‑28%, compared with 72‑89%, respectively.

Patients with Medicaid and those who were uninsured were considered to be underinsured, note the researchers.

After exclusion of potentially confounding factors in analysis, such as race, age, marital status, and disease severity (measured on the All Patient Refined Diagnosis Related Groups score), being underinsured increased the mortality risk by a significant 31% in patients admitted for acute MI.

Similarly, the mortality risk among underinsured patients admitted to hospital for coronary atherosclerosis was a significant 50% higher than those with private insurance, while underinsured stroke patients had a 25% higher risk for death compared with their insured peers, but the difference was nonsignificant.

Conversely, race (Black versus White) had no significant effect on the risk for mortality among acute MI patients or stroke patients, whereas Black patients had a moderately significant 18% reduced risk for death after coronary atherosclerosis compared with their White counterparts.

Overall, underinsured patients died sooner than their peers with insurance, while survival length was similar between White and Black patients, found Ng et al.

"In this analysis, insurance status is likely a proxy for access to care and subsequent poor or incomplete management of cardiovascular risk factors among those with CVD [cardiovascular disease]," remark the study authors.

"Our results support the expansion of state-based insurance coverage with services comparable to private insurance as a potentially effective approach to closing mortality disparities due to CVD," they conclude.

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