S52 Does Insurance Status Impact Inpatient Complications in Adult Patients Hospitalized With Acute Pancreatitis? A National Inpatient Sampling Database Study

Abstract

Introduction: Treatment disparities secondary to different insurance statuses have been widely implicated as an important predictor of morbidity and mortality for a wide array of different diseases. We aim to evaluate the impact of insurance status on inpatient complications using a longitudinal hospital care database. Methods: The National Inpatient Sampling database (201-2015q3) was queried to identify patients hospitalized for acute pancreatitis. Patient demographics and inpatient complications were crossmatched with insurance statuses, including Private, Medicare, Medicaid, self-pay, and other government insurance plan(s). Inpatient complications included urinary tract infections (UTIs), pneumonia/respiratory complications, acute respiratory distress syndrome (ARDS), systemic inflammatory response syndrome (SIRS), acute myocardial infarction (MI), stroke, shock, and acute kidney injury (AKI). Multivariate logistic regression analysis was used to assess whether varying insurance type, as compared to private insurance, was associated with a difference in the rates of inpatient complications, after controlling for baseline demographics and hospital characteristics. Results: A total of 1,379,113 patients were admitted for acute pancreatitis between 2010-September 2015 of which 31.9% had private insurance, 31.4% had Medicare, 17.7% had Medicaid, 14.6% were insured (cash/self-pay), 4.0% had other government insurance, and 0.3% had missing/unknown insurance. As compared to private insurance beneficiaries, patients with Medicare had increased odds of UTI (OR 1.22 [95% CI 1.19-1.25]; p< 0.001) and acute MI (OR 1.40 [95% CI 1.28-1.53]; p< 0.001), but lower odds of respiratory complications (OR 0.93 [95% CI 0.90-0.96]; p< 0.001), AKI (OR 0.89 [95% CI 0.86-0.90]; p< 0.001), shock (OR 0.60 [95% CI 0.51-0.70]; p< 0.001), ARDS (OR 0.93 [95% CI 0.89-0.96]; p< 0.001), SIRS (OR 0.86 [95% CI 0.82-0.90]; p< 0.001) and thromboembolic events (OR 0.80 [95% CI 0.73-0.87]; p< 0.001). Patients with Medicaid had higher odds of UTI (p< 0.001), stroke (OR (P=0.012), respiratory complications (P=0.008), acute MI (P=0.001), sepsis (p< 0.001), but lower odds of shock (p< 0.001), ARDS (p< 0.001) and SIRS (p< 0.001). Conclusion: The above results show the disparity in inpatient complications among patients admitted for acute pancreatitis based on their insurance status. Medicaid patients were most significantly predisposed to poor clinical outcomes. Further studies are required to recognize the rationale for these discrepancies.