Lack of insurance as a barrier to care in sepsis: A retrospective cohort study

Abstract

Nationally-representative data suggest an association between lack of insurance and in-hospital death from sepsis (Kumar et al., 2014). It remains to be determined whether this association is attributable to differences in baseline health, care-seeking behaviors, hospital care, or other factors. PurposeTo determine whether organ dysfunction present on admission for community-onset sepsis mediates the association between lack of insurance and mortality in sepsis. Materials and methodsRetrospective cohort study using public discharge data from the California Office of Statewide Health Planning and Development. Inpatients age 18–64 with community-onset sepsis at California hospitals in 2010 were identified by diagnosis codes. ResultsControlling for demographics, comorbidities, infection source, and hospital characteristics, lack of insurance was associated with an adjusted odds ratio (OR) of 1.26 (absolute risk difference 4.75%, p<0.001) for organ dysfunction present on admission for community-onset sepsis. Lack of insurance predicted in-hospital mortality (adjusted OR 1.15, p<0.001). Organ dysfunction present on admission was the only significant mediator, explaining 22.3% (p<0.001) of the effect of lack of insurance. ConclusionsThe association between lack of insurance and organ dysfunction on admission in community-onset sepsis suggests that lack of insurance may impede timely care for patients with community-onset infections.