DIFFERENCE IN HEALTHCARE OUTCOMES BETWEEN PUBLIC AND PRIVATE PAYERS FOR PATIENTS ADMITTED WITH CROHN'S DISEASE

Abstract

Abstract BACKGROUND In countries where health coverage is not universal, there is ample evidence of disparities in healthcare, often associated with insurance. Crohn’s disease (CD) is a complex chronic disease with potential for significant morbidity if the content or delivery of healthcare is suboptimal. However, the literature related to primary payers and CD remains lacking. METHODS We queried the National Inpatient Sample (NIS)from 2016-2019 using ICD10-CM/PCS codes to identify hospital discharges with a diagnosis of CD. Patients were subsequently stratified based on insurance (Medicare, Medicaid, Private, and No insurance). Observations were categorized into two groups, private and public (Medicare and Medicaid) insurance. Patients without insurance were excluded from the study. In-hospital mortality, total hospital cost, length of stay, and in-hospital complications were evaluated. Multivariate logistic regression analysis was conducted to adjust for confounders. RESULTS A total of 135,075 discharges with diagnosis of CD were identified with a primary payer insurance, of which 70,275(52.1%) had private insurance and 64,800 (47.9%) public. Patients with private insurance were more likely to be white (68.9% vs 78.4%; P<0.01), have lower Charlson score (46.1% vs 59.1%; P<0.01), belong to the higher income bracket (16.7% vs 29.6%; P<0.01), be admitted to a teaching institution (74.2% vs 79.4%; P<0.01), and be in an urban setting (92.2% vs 95.5%; P<0.01). Patients with private insurance were less likely to require parenteral nutrition (5.9% vs 5.3%; P=0.04), have severe malnutrition (8.8% vs 6.4%; P<0.01), abuse EtOH (1.7% vs 0.8%; P<0.01), use tobacco (1.4% vs 1.1%; P<0.01), use cannabis (4.2% vs 2.3%; P<0.01), have iron deficiency anemia (13.4% vs 11.6%; P<0.01), and die during hospitalization (0.4% vs 0.1%; P<0.01). On multivariate analysis, there was lower mortality in patients with a private primary payer [0.28; (P<0.01)], shorter LOS (5.8 vs 4.9 days mean days; P<0.01), and lower healthcare charges [ -3,903 US$; (P<0.01)]. Overall, those with private insurance had lower in-hospital complications such as respiratory failure [aOR 0.75; (P=0.05)], endotracheal intubation [aOR 0.50; (P<0.01)], prolonged mechanical ventilation [aOR 0.36;(P<0.01)], hemodialysis [aOR 0.34; (P<0.01)], acute kidney injury [aOR 0.72; (P<0.01)], and venous thromboembolism [aOR 0.54; (P<0.01)]. However, they had higher rates of surgical interventions including small bowel resection [aOR 1.57; (P<0.01)], large bowel resection [aOR 1.58; (P<0.01)], laparoscopic surgery [aOR 2.44; (P<0.01)], and to require conversion to open surgery [aOR 1.55; (P<0.01)]. CONCLUSIONS Our findings suggest that primary public payers were independently associated with higher morbidity and mortality in patients admitted with CD.