Association Of Loss Of Commercial Insurance And The Risk Of Lower Extremity Amputation In Peripheral Artery Disease

Abstract

INTRODUCTION METHOD The PearlDiver insurance claims dataset (2010 to 2019) was queried for adult patients (>18 years) with commercial insurance and at least three years continuous enrollment after PAD diagnosis. Patients were categorized into continuous cohort (continue commercial insurance coverage) and loss of insurance cohort (transition to Medicaid or no insurance). Logistic regression was performed for the crude cohort and propensity matched cohort (using age, gender, and Charleston Comorbidity Index) to evaluate association between loss of insurance and risk of major and minor amputation. RESULTS We identified N=92,772 patients with continuous commercial insurance during the three-year query period and N=213,097 patients who had interrupted coverage. In the crude cohort, loss of insurance was associated with 77% higher risk of major amputation (95% confidence interval (CI) 1.49-2.12) and 42% higher risk of minor amputation (95% CI 1.31-1.53). Matched cohort showed similar results in a subset of N=91,480 patients, with 233% higher risk of major amputation (95% CI 1.96-2.80) and 203% higher risk of minor amputation (95% CI 1.88-2.21) in the loss of insurance group. CONCLUSIONS Loss of commercial insurance is associated with increased risk of major and minor amputations in PAD patients. This may be related to delayed presentation to primary or specialty care, variations in physician willingness to treat uninsured patients, and differences in available treatment options. The PearlDiver insurance claims dataset (2010 to 2019) was queried for adult patients (>18 years) with commercial insurance and at least three years continuous enrollment after PAD diagnosis. Patients were categorized into continuous cohort (continue commercial insurance coverage) and loss of insurance cohort (transition to Medicaid or no insurance). Logistic regression was performed for the crude cohort and propensity matched cohort (using age, gender, and Charleston Comorbidity Index) to evaluate association between loss of insurance and risk of major and minor amputation. We identified N=92,772 patients with continuous commercial insurance during the three-year query period and N=213,097 patients who had interrupted coverage. In the crude cohort, loss of insurance was associated with 77% higher risk of major amputation (95% confidence interval (CI) 1.49-2.12) and 42% higher risk of minor amputation (95% CI 1.31-1.53). Matched cohort showed similar results in a subset of N=91,480 patients, with 233% higher risk of major amputation (95% CI 1.96-2.80) and 203% higher risk of minor amputation (95% CI 1.88-2.21) in the loss of insurance group. Loss of commercial insurance is associated with increased risk of major and minor amputations in PAD patients. This may be related to delayed presentation to primary or specialty care, variations in physician willingness to treat uninsured patients, and differences in available treatment options.