Abstract
ObjectivesHealth insurance is associated with better outcomes in the admitted patient population, even after adjusting for other factors such as race and socioeconomic status. However, the literature is limited on the relationship between insurance status and hospital outcomes in patients hospitalized with the disease of nervous system.MethodsThis cross-sectional study used the Nationwide Inpatient Sample (NIS) database to achieve the results. All Major Diagnostic Category (MDC) codes from patients discharged for disease and disorders of nervous system between the years 2005 to 2014 were queried and analyzed for the impact of lack of insurance on patient outcome.ResultsAmong 4,737,999 discharges, 5.6% had no insurance. The hospital mortality rate among uninsured and insured patients was 4.1% and 3.7%, respectively (P<0.001). In the multivariate analysis, hospital mortality of uninsured patients was higher in the elderly (aOR: 4.74[CI:4.52-4.97], P<0.001), those with comorbidities (aOR: 2.23[CI:2.18-2.27], P<0.001), Asians (aOR: 1.16[CI:1.12-1.20]. P<0.001), in rural areas (aOR: 1.44[ 95%CI:1.41-1.48], P<0.001) and those in the lowest household income quartile (aOR: 1.03[CI:1.01-1.05], P<0.001). The average length of stay (LOS) was shorter for the uninsured (4.79±8.26 vs 4.96±7.55 days, P<0.001).ConclusionsThe findings suggest that lack of health insurance is correlated with hospital mortality in patients hospitalized with disease and disorders of nervous system, with an increased disparity in vulnerable populations.
Highlights
According to a 2019 Gallup poll, 25% of Americans delayed treatment for a serious condition due to costs, compared to 12% of Americans in 2001
Hospital mortality of uninsured patients was higher in the elderly, those with comorbidities, Asians
The findings suggest that lack of health insurance is correlated with hospital mortality in patients hospitalized with disease and disorders of nervous system, with an increased disparity in vulnerable populations
Summary
According to a 2019 Gallup poll, 25% of Americans delayed treatment for a serious condition due to costs, compared to 12% of Americans in 2001. Studies utilizing a spectrum of methods ranging from observational to cohort to quasiexperimental have suggested that health insurance has a positive effect on health outcomes [2]. A 1993 cohort study found that those without insurance were 1.25 times more likely to die after adjusting for other factors [3]. A 2009 cohort study found that those without insurance were 1.4 times more likely to die [4]. This finding was confirmed by a 2017 review of 18 internal medicine studies [5]. Insurance status has a stronger association with mortality than other significant factors such as race [6]
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