Stroke Program, University of Michigan Medical School, Ann Arbor, USA.
Neurology. 2012 May 15;78(20):1590-5. doi: 10.1212/WNL.0b013e3182563bf5. Epub 2012 May 2.
Utilization of postacute care is associated with improved poststroke outcomes. However, more than 20% of American adults under age 65 are uninsured. We sought to determine whether insurance status is associated with utilization and intensity of institutional postacute care among working age stroke survivors.
A retrospective cross-sectional study of ischemic stroke survivors under age 65 from the 2004-2006 Nationwide Inpatient Sample was conducted. Hierarchical logistic regression models controlling for patient and hospital-level factors were used. The primary outcome was utilization of any institutional postacute care (inpatient rehabilitation or skilled nursing facilities) following hospital admission for ischemic stroke. Intensity of rehabilitation was explored by comparing utilization of inpatient rehabilitation facilities and skilled nursing facilities.
Of the 33,917 working age stroke survivors, 19.3% were uninsured, 19.8% were Medicaid enrollees, and 22.8% were discharged to institutional postacute care. Compared to those privately insured, uninsured stroke survivors were less likely (adjusted odds ratio [AOR] 0.53, 95% confidence interval [CI] 0.47-0.59) while stroke survivors with Medicaid were more likely to utilize any institutional postacute care (AOR = 1.40, 95% CI 1.27-1.54). Among stroke survivors who utilized institutional postacute care, uninsured (AOR = 0.48, 95% CI 0.36-0.64) and Medicaid stroke survivors (AOR = 0.27, 95% CI 0.23-0.33) were less likely to utilize an inpatient rehabilitation facility than a skilled nursing facility compared to privately insured stroke survivors.
Insurance status among working age acute stroke survivors is independently associated with utilization and intensity of institutional postacute care. This may explain differences in poststroke outcomes among uninsured and Medicaid stroke survivors compared to the privately insured.
接受急性后期治疗与改善脑卒中预后相关。然而，超过 20%的美国 65 岁以下成年人没有保险。我们旨在确定保险状况是否与工作年龄脑卒中幸存者的机构急性后期治疗的使用和强度相关。
对 2004-2006 年全国住院患者样本中年龄在 65 岁以下的缺血性脑卒中幸存者进行回顾性横断面研究。使用控制患者和医院水平因素的分层逻辑回归模型。主要结局是缺血性脑卒中住院后是否使用任何机构急性后期治疗（住院康复或熟练护理设施）。通过比较使用住院康复设施和熟练护理设施来探讨康复强度。
在 33917 名工作年龄的脑卒中幸存者中，19.3%没有保险，19.8%是医疗补助计划的参保人，22.8%出院到机构急性后期治疗。与私人保险相比，没有保险的脑卒中幸存者不太可能（调整后的优势比[OR]0.53，95%置信区间[CI]0.47-0.59），而有医疗补助的脑卒中幸存者更有可能使用任何机构急性后期治疗（OR=1.40，95%CI 1.27-1.54）。在使用机构急性后期治疗的脑卒中幸存者中，没有保险（OR=0.48，95%CI 0.36-0.64）和医疗补助的脑卒中幸存者（OR=0.27，95%CI 0.23-0.33）与私人保险的脑卒中幸存者相比，更不可能使用住院康复设施，而使用熟练护理设施。
工作年龄急性脑卒中幸存者的保险状况与机构急性后期治疗的使用和强度独立相关。这可能解释了与私人保险的脑卒中幸存者相比，没有保险和医疗补助的脑卒中幸存者在脑卒中后结局方面的差异。
