Department of Medicine, Division of Cardiovascular Medicine, State University of New York, Stony Brook University Medical Center, Stony Brook, NY, USA.
Am Heart J. 2011 Sep;162(3):512-7. doi: 10.1016/j.ahj.2011.06.002. Epub 2011 Jul 26.
The aim of this study was to determine if insurance status is associated with adverse outcomes in patients with coronary artery disease.
A cohort of 13,456 patients who underwent percutaneous coronary intervention (PCI) between January 1, 2004, and December 31, 2007, at 4 New York State teaching hospitals was retrospectively studied. The primary outcome of interest was in-hospital mortality from any cause.
Of the 13,456 patients studied, 11,927 (88.6%) were insured by private carriers, 1,036 (7.7%) patients were covered by Medicaid, and 493 (3.7%) were uninsured. Uninsured and Medicaid patients tended to be younger and more often nonwhite and Hispanic. They had a higher prevalence of congestive heart failure and worse left ventricular function. Compared with privately insured patients, uninsured and Medicaid patients had increased all-cause mortality (1.2% and 0.9%, respectively, vs 0.3%; P < .001). For all patients, lack of insurance (OR 3.02, 95% CI 1.10-8.28) and Medicaid (OR 4.39, 95% CI 1.93-9.99) were independently associated with mortality. Lack of insurance (OR 5.02, 95% CI 1.58-15.93) and Medicaid (OR 4.55, 95% CI 1.19-17.45) were also independently associated with increased mortality in patients undergoing emergent PCI.
Lack of insurance and Medicaid insurance are both independently associated with an increased risk of in-hospital mortality after PCI for coronary artery disease.
本研究旨在确定保险状况是否与冠心病患者的不良结局相关。
回顾性研究了 2004 年 1 月 1 日至 2007 年 12 月 31 日期间在纽约州 4 家教学医院接受经皮冠状动脉介入治疗（PCI）的 13456 例患者。主要研究终点为任何原因导致的院内死亡率。
在研究的 13456 例患者中，11927 例（88.6%）由私人保险公司承保，1036 例（7.7%）患者由医疗补助计划（Medicaid）覆盖，493 例（3.7%）未参保。未参保和 Medicaid 患者往往更年轻，且更多是非裔和西班牙裔。他们充血性心力衰竭和左心室功能更差的发生率更高。与私人保险患者相比，未参保和 Medicaid 患者的全因死亡率更高（分别为 1.2%和 0.9%，而 0.3%；P<0.001）。对于所有患者，缺乏保险（OR 3.02，95%CI 1.10-8.28）和 Medicaid（OR 4.39，95%CI 1.93-9.99）与死亡率独立相关。缺乏保险（OR 5.02，95%CI 1.58-15.93）和 Medicaid（OR 4.55，95%CI 1.19-17.45）与急诊 PCI 后患者死亡率增加也独立相关。
缺乏保险和 Medicaid 保险与冠心病 PCI 后院内死亡率增加独立相关。
