Abstract WP481: Regional Differences in Hospital Setting and Insurance Coverage in Patients Included in the National Inpatient Sample Database 2006-2014 With Vascular Dementia

Abstract

Introduction: Evaluation of healthcare utilization in patients hospitalized with vascular dementia (VD) in the United States (US) and regionally have not recently been reported. Patients with VD have higher healthcare utilization and costs than other forms of dementia. We previously found regional differences in frequency at which VD patients were hospitalized in the National Inpatient Sample (NIS), with lower frequency being found in the West. Thus, we hypothesized that payor/insurance type and hospital setting may vary regionally. Methods: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database from 2006-2014 was used to query patients with primary or secondary ICD-9 for VD using ICD-9 codes 290.40, 290.41, 290.43. Regional differences in frequency of VD diagnosis were evaluated within the NIS dividing the US into four hospital regions (Northeast, Midwest, South, and West). Comparison of the observed distribution of insurance status and hospital type were performed with Chi-square analysis and patient demographics with Mann Whitney test. Results: There were no significant regional differences in patient demographics. Nationally, 88% of patients were insured with Medicare, 6% private, 4% Medicaid, 1% self-pay, and 1% were not charged. There were no significant differences in the distribution of insurance coverage by region. In contrast, the distribution of patients admitted with VD in the Northeast (p=0.00790) and West (p=0.0018) were significantly different from the national distribution, which included 15% in rural, 42% urban non-teaching, and 43% teaching hospital setting. In the Northeast 7% were admitted to rural hospitals, 36% urban non-teaching, and 57% teaching hospitals. In the West 6% were admitted to rural hospitals, 58% urban non-teaching, and 36% teaching hospitals. Conclusion: While payor and insurance status did not vary regionally, the hospital type did vary regionally. A significant proportion were covered with Medicare. This is likely related to the age at which the patients progress from mild cognitive impairment to vascular dementia. More research is needed to determine if healthcare utilization by hospital type impacts costs and clinical outcome.