Abstract
IntroductionSocio-demographic and clinical factors associated with increased sepsis risk, including older age, non-white race and specific co-morbidities, are more common among patients with Medicare or Medicaid or no health insurance. We hypothesized that patients with Medicare and/or Medicaid or without health insurance have a higher risk of sepsis-associated hospitalization or sepsis-associated death than those with private health insurance.MethodsWe performed a retrospective cohort study of records from the 2003 Nationwide Inpatient Sample. We stratified the study cohort by Medicare age-qualification (18 to 64 and 65+ years old). We examined the association between insurance category and sepsis diagnosis and death among admissions involving sepsis. We used validated diagnostic codes to determine the presence of sepsis, co-morbidities and organ dysfunction and to provide risk-adjustment.ResultsAmong patients 18 to 64 years old, those with Medicaid (adjusted odds ratio (AOR) 1.50), Medicare (AOR 1.96), Medicaid + Medicare (AOR 2.22) and the uninsured (AOR 1.18) had significantly higher risk-adjusted odds of a sepsis-associated admission than those with private insurance (all P < 0.0001). Those with Medicaid (AOR 1.17, P < 0.001) and those without insurance (AOR 1.45, P < 0.001) also had significantly higher adjusted odds of sepsis-associated hospital mortality than those with private insurance. Among those 65+ years old, those with Medicaid (AOR 1.43), Medicare alone (AOR 1.13) or Medicaid + Medicare (AOR 1.62) had significantly higher risk-adjusted odds of sepsis-associated admission than those with private insurance and Medicare (all P < 0.0001). Among sepsis patients 65+, uninsured patients had significantly higher risk-adjusted odds (AOR 1.45, P = 0.0048) and those with Medicare alone had significantly lower risk-adjusted odds (AOR 0.92, P = 0.0072) of hospital mortality than those with private insurance and Medicare. Lack of health insurance remained associated with sepsis-associated mortality after stratification of hospitals into quartiles based on rates of sepsis-associated admissions or mortality in both age strata.ConclusionsRisks of sepsis-associated hospitalization and sepsis-associated death vary by insurance. These increased risks were not fully explained by the available socio-demographic factors, co-morbidities or hospital rates of sepsis-related admissions or deaths.
Highlights
Socio-demographic and clinical factors associated with increased sepsis risk, including older age, non-white race and specific co-morbidities, are more common among patients with Medicare or Medicaid or no health insurance
Insurance category and sepsis-associated mortality Table 5 shows the age-strata-specific discharge disposition and hospital length of stay by insurance category. In both age strata, uninsured sepsis patients were most likely to die during hospitalization and least likely to be discharged to an intermediate/skilled nursing facility
Mechanisms related to social disadvantages related to a lack of private insurance are likely contributors to the observed results, including those resulting from a lack of
Summary
Socio-demographic and clinical factors associated with increased sepsis risk, including older age, non-white race and specific co-morbidities, are more common among patients with Medicare or Medicaid or no health insurance. We hypothesized that patients with Medicare and/or Medicaid or without health insurance have a higher risk of sepsis-associated hospitalization or sepsis-associated death than those with private health insurance. In 1995, there were approximately 750,000 cases of sepsis in the United States (US) with a 30% mortality rate during hospitalization, resulting in 215,000 deaths annually [1]. Some risk factors for sepsis and sepsis-related mortality, including older age, non-white race, and specific comorbidities, are more common among patients with. Differences in insurance coverage may be associated with risk of sepsis or sepsis-related mortality because of differences in access to care, disparities in provided care, overall health status or other unknown factors. An association between insurance coverage and sepsis, which is independent of known risk factors, would call attention to these disparities in risk for sepsis and poorer outcomes from sepsis among those without private insurance and exploration of the mechanism of such a relationship to identify modifiable factors
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