Department of Neurosurgery, Brigham and Women's Hospital, Children's Hospital of Boston, Harvard Medical School, Boston, Massachusetts, USA.
Cancer. 2012 Oct 1;118(19):4833-41. doi: 10.1002/cncr.27388. Epub 2012 Jan 31.
Disparities based on insurance status in the American health care system are well established. However, to the authors' knowledge, this is the first study to evaluate variables that may explain differences based on payer type in the outcomes after surgery for spinal metastases.
Data from the Nationwide Inpatient Sample (2005-2008) were retrospectively extracted. Patients ages 18 to 64 years who underwent surgery for spinal metastases were included. Multivariate logistic regression was performed to calculate the adjusted odds of in-hospital death and the development of a complication for Medicaid recipients and for those without insurance compared with privately insured patients. All analyses were adjusted for differences in patient age, gender, primary tumor histology, socioeconomic status, hospital bed size, and hospital teaching status.
A total of 2157 hospital admissions were evaluated. The adjusted odds of in-hospital death were significantly higher for Medicaid recipients (crude rate: 6.5%; odds ratio [OR], 1.79; 95% confidence interval [95% CI], 1.11-2.88 [P = .02]) and uninsured patients (crude rate: 7.7%; OR, 2.15; 95% CI, 1.04-4.46 [P = .04]) compared with privately insured patients (crude rate: 3.8%). Complication rates were also significantly higher for Medicaid recipients (OR, 1.34; 95% CI, 1.04-1.72 [P = .02]). However, after also adjusting for acuity of presentation, the odds of in-hospital death were not significantly different for Medicaid (OR, 1.38; 95% CI, 0.86-2.21 [P = .18]) or uninsured patients (OR, 1.86; 95% CI, 0.90-3.83 [P = .09]); in addition, complication rates did not appear to differ significantly.
This nationwide study suggests that disparities based on insurance status for patients undergoing surgery for spinal metastases may be attributable to a higher acuity of presentation.
在美国医疗保健系统中，基于保险状况的差异是众所周知的。然而，据作者所知，这是第一项评估可能导致脊柱转移瘤手术后根据付款人类型出现结果差异的变量的研究。
从 2005 年至 2008 年的全国住院患者样本中回顾性提取数据。纳入年龄在 18 至 64 岁之间接受脊柱转移瘤手术的患者。采用多变量逻辑回归计算医疗保险受益人和无保险患者与私人保险患者相比，住院期间死亡和并发症发展的调整后优势比。所有分析均根据患者年龄、性别、原发肿瘤组织学、社会经济地位、医院床位大小和医院教学地位的差异进行调整。
共评估了 2157 例住院病例。医疗保险受益人的住院期间死亡调整后优势比明显更高（粗率：6.5%；优势比 [OR]，1.79；95%置信区间 [95%CI]，1.11-2.88 [P =.02]）和无保险患者（粗率：7.7%；OR，2.15；95%CI，1.04-4.46 [P =.04]）与私人保险患者（粗率：3.8%）相比。医疗保险受益人的并发症发生率也明显更高（OR，1.34；95%CI，1.04-1.72 [P =.02]）。然而，在调整了表现的严重程度后，医疗保险患者的住院期间死亡优势比无显著差异（OR，1.38；95%CI，0.86-2.21 [P =.18]）或无保险患者（OR，1.86；95%CI，0.90-3.83 [P =.09]）；此外，并发症发生率似乎也没有明显差异。
这项全国性研究表明，接受脊柱转移瘤手术的患者基于保险状况的差异可能归因于表现的严重程度更高。
