Association of Health Insurance Status with Outcomes of Sepsis in Adult Patients: A Retrospective Cohort Study.

Gaon-Sorae Wang,Ji-Eun Hwang,You-Hwan Jo,Yoon-Sun Jung,Kyoung-Min You,Jong-Hwan Shin,Hui-Jai Lee

doi:10.3390/ijerph18115777

Abstract

(1) Background: Sepsis is a life-threatening disease, and various demographic and socioeconomic factors affect outcomes in sepsis. However, little is known regarding the potential association between health insurance status and outcomes of sepsis in Korea. We evaluated the association of health insurance and clinical outcomes in patients with sepsis. (2) Methods: Prospective cohort data of adult patients with sepsis and septic shock from March 2016 to December 2018 in three hospitals were retrospectively analyzed. We categorized patients into two groups according to their health insurance status: National Health Insurance (NHI) and Medical Aid (MA). The primary end point was in-hospital mortality. The multivariate logistic regression model and propensity score matching were used. (3) Results: Of a total of 2526 eligible patients, 2329 (92.2%) were covered by NHI, and 197 (7.8%) were covered by MA. The MA group had fewer males, more chronic kidney disease, more multiple sources of infection, and more patients with initial lactate > 2 mmol/L. In-hospital, 28-day, and 90-day mortality were not significantly different between the two groups and in-hospital mortality was not different in the subgroup analysis. Furthermore, health insurance status was not independently associated with in-hospital mortality in multivariate analysis and was not associated with survival outcomes in the propensity score-matched cohort. (4) Conclusions: Our propensity score-matched cohort analysis demonstrated that there was no significant difference in in-hospital mortality by health insurance status in patients with sepsis.

Highlights

Sepsis is a life-threatening organ dysfunction resulting from infection and is a major healthcare problem
Using multicenter collected hospital-based data and electrical medical records (EMRs), we evaluated the association between health insurance status and clinical outcomes in sepsis
Patients with follow-up loss (n = 152), those who transferred to another hospital (n = 1667), and those who had unknown information on their health insurance status or health insurance status coded as “no charge” or “other” (n = 98) were excluded from the analysis

Summary

Introduction

Sepsis is a life-threatening organ dysfunction resulting from infection and is a major healthcare problem. There were approximately 970,000 hospital admissions for sepsis in the United States (US) annually [1]. The number of sepsis cases has been rising over the years, and the costs of sepsis-related hospitalizations are more than $24 billion [1]. Despite improvements in sepsis treatment in line with findings from the Surviving Sepsis. Sepsis accounts for more than 50% of hospital deaths and 30-day mortality remains above 30% among patients with severe sepsis [1,2]. Survivors of sepsis may experience prolonged physical and neuropsychological morbidity [3,4], which causes loss of employment or need of caregiver assistance [5].

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