The association of lacking insurance with outcomes of severe sepsis: retrospective analysis of an administrative database*. Crit Care Med 2014 Mar;42(3):583-91
Date
10/25/2013Pubmed ID
24152590Pubmed Central ID
PMC4990450DOI
10.1097/01.ccm.0000435667.15070.9cScopus ID
2-s2.0-84894481253 (requires institutional sign-in at Scopus site) 40 CitationsAbstract
OBJECTIVE: Patients with severe sepsis have high mortality that is improved by timely, often expensive, treatments. Patients without insurance are more likely to delay seeking care; they may also receive less intense care.
DESIGN: We performed a retrospective analysis of administrative database-Healthcare Costs and Utilization Project's Nationwide Inpatient Sample-to test whether mortality is more likely among uninsured patients hospitalized for severe sepsis.
PATIENTS: None.
INTERVENTIONS: We used International Classification of Diseases-9th Revision, Clinical Modification, codes indicating sepsis and organ system failure to identify hospitalizations for severe sepsis among patients aged 18-64 between 2000 and 2008. We excluded patients with end-stage renal disease or solid organ transplants because very few are uninsured. We performed multivariate logistic regression modeling to examine the association of insurance status and in-hospital mortality, adjusted for patient and hospital characteristics. We performed subgroup analysis to examine whether the impact of insurance status varied by geographical region; by patient age, sex, or race; or by hospital characteristics such as teaching status, size, or ownership. We used similar methods to examine the impact of insurance status on the use of certain procedures, length of stay, and discharge destination.
MEASUREMENTS AND MAIN RESULTS: There were 1,600,269 discharges with severe sepsis from 2000 through 2008 in the age group 18-64 years. Uninsured people, who accounted for 7.5% of admissions with severe sepsis, had higher adjusted odds of mortality (odds ratio, 1.43; 95% CI, 1.37-1.47) than privately insured people. The higher mortality in uninsured was present in all subgroups and was similar in each year from 2000 to 2008. After adjustment, uninsured individuals had a slightly shorter length of stay than insured people and were less likely to receive five of the six interventions we examined. They were also less likely to be discharged to skilled nursing facilities or with home healthcare after discharge.
CONCLUSIONS: Uninsured are more likely to die following admission for severe sepsis than patients with insurance, even after adjusting for potential confounders. This was not due to a hospital effect or demographic or clinical factors available in our administrative database. Further research should examine the mechanisms that lead to this association.
Author List
Kumar G, Taneja A, Majumdar T, Jacobs ER, Whittle J, Nanchal R, Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of InvestigatorsAuthors
Rahul Sudhir Nanchal MD Professor in the Medicine department at Medical College of WisconsinAmit Taneja MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Cause of Death
Cohort Studies
Databases, Factual
Female
Follow-Up Studies
Healthcare Disparities
Hospital Mortality
Humans
Insurance Coverage
Insurance, Health
International Classification of Diseases
Logistic Models
Male
Medically Uninsured
Middle Aged
Multivariate Analysis
Retrospective Studies
Risk Assessment
Sepsis
Survival Rate
Treatment Outcome
United States
Young Adult
