Insurance-based Disparities in Outcomes and Extracorporeal Membrane Oxygenation Utilization for Hospitalized COVID-19 Patients.

Autor:	Glance LG; Departments of Anesthesiology and Perioperative Medicine and of Public Health Sciences, University of Rochester School of Medicine, Rochester, New York; and RAND Health, RAND, Boston, Massachusetts., Joynt Maddox KE; Department of Medicine, Washington University in St. Louis, St. Louis, MO.; Center for Advancing Health Services, Policy & Economics Research, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri., Mazzeffi M; Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia., Shippey E; Vizient Center for Advanced Analytics, Chicago, Illinois., Wood KL; Department of Surgery (Cardiac), University of Rochester School of Medicine, Rochester, New York., Yoko Furuya E; Department of Medicine, Division of Infectious Diseases Columbia University Irving Medical Center, New York, New York., Stone PW; Columbia University School of Nursing, Center for Health Policy, New York, New York., Shang J; Columbia University School of Nursing, Center for Health Policy, New York, New York., Wu IY; Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York., Gosev I; Department of Surgery (Cardiac), University of Rochester School of Medicine, Rochester, New York., Lustik SJ; Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York., Lander HL; Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York., Wyrobek JA; Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York., Laserna A; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California., Dick AW; RAND Health, RAND, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Anesthesiology [Anesthesiology] 2024 Jul 01; Vol. 141 (1), pp. 116-130.
DOI:	10.1097/ALN.0000000000004985
Abstrakt:	Background: The objective of this study was to examine insurance-based disparities in mortality, nonhome discharges, and extracorporeal membrane oxygenation utilization in patients hospitalized with COVID-19. Methods: Using a national database of U.S. academic medical centers and their affiliated hospitals, the risk-adjusted association between mortality, nonhome discharge, and extracorporeal membrane oxygenation utilization and (1) the type of insurance coverage (private insurance, Medicare, dual enrollment in Medicare and Medicaid, and no insurance) and (2) the weekly hospital COVID-19 burden (0 to 5.0%; 5.1 to 10%, 10.1 to 20%, 20.1 to 30%, and 30.1% and greater) was evaluated. Modeling was expanded to include an interaction between payer status and the weekly hospital COVID-19 burden to examine whether the lack of private insurance was associated with increases in disparities as the COVID-19 burden increased. Results: Among 760,846 patients hospitalized with COVID-19, 214,992 had private insurance, 318,624 had Medicare, 96,192 were dually enrolled in Medicare and Medicaid, 107,548 had Medicaid, and 23,560 had no insurance. Overall, 76,250 died, 211,702 had nonhome discharges, 75,703 were mechanically ventilated, and 2,642 underwent extracorporeal membrane oxygenation. The adjusted odds of death were higher in patients with Medicare (adjusted odds ratio, 1.28 [95% CI, 1.21 to 1.35]; P < 0.0005), dually enrolled (adjusted odds ratio, 1.39 [95% CI, 1.30 to 1.50]; P < 0.0005), Medicaid (adjusted odds ratio, 1.28 [95% CI, 1.20 to 1.36]; P < 0.0005), and no insurance (adjusted odds ratio, 1.43 [95% CI, 1.26 to 1.62]; P < 0.0005) compared to patients with private insurance. Patients with Medicare (adjusted odds ratio, 0.47; [95% CI, 0.39 to 0.58]; P < 0.0005), dually enrolled (adjusted odds ratio, 0.32 [95% CI, 0.24 to 0.43]; P < 0.0005), Medicaid (adjusted odds ratio, 0.70 [95% CI, 0.62 to 0.79]; P < 0.0005), and no insurance (adjusted odds ratio, 0.40 [95% CI, 0.29 to 0.56]; P < 0.001) were less likely to be placed on extracorporeal membrane oxygenation than patients with private insurance. Mortality, nonhome discharges, and extracorporeal membrane oxygenation utilization did not change significantly more in patients with private insurance compared to patients without private insurance as the COVID-19 burden increased. Conclusions: Among patients with COVID-19, insurance-based disparities in mortality, nonhome discharges, and extracorporeal membrane oxygenation utilization were substantial, but these disparities did not increase as the hospital COVID-19 burden increased. (Copyright © 2024 American Society of Anesthesiologists. All Rights Reserved.)
Databáze:	MEDLINE
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