Stecker Eric C, Reinier Kyndaron, Rusinaru Carmen, Uy-Evanado Audrey, Jui Jon, Chugh Sumeet S
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
J Am Heart Assoc. 2017 Jun 28;6(7):e005667. doi: 10.1161/JAHA.117.005667.
Health insurance has many benefits including improved financial security, greater access to preventive care, and better self-perceived health. However, the influence of health insurance on major health outcomes is unclear. Sudden cardiac arrest prevention represents one of the major potential benefits from health insurance, given the large impact of sudden cardiac arrest on premature death and its potential sensitivity to preventive care.
We conducted a pre-post study with control group examining out-of-hospital cardiac arrest (OHCA) among adult residents of Multnomah County, Oregon (2015 adult population 636 000). Two time periods surrounding implementation of the Affordable Care Act were evaluated: 2011-2012 ("pre-expansion") and 2014-2015 ("postexpansion"). The change in OHCA incidence for the middle-aged population (45-64 years old) exposed to insurance expansion was compared with the elderly population (age ≥65 years old) with constant near-universal coverage. Rates of OHCA among middle-aged individuals decreased from 102 per 100 000 (95% CI: 92-113 per 100 000) to 85 per 100 000 (95% CI: 76-94 per 100 000), value 0.01. The elderly population experienced no change in OHCA incidence, with rates of 275 per 100 000 (95% CI: 250-300 per 100 000) and 269 per 100 000 (95% CI: 245-292 per 100 000), value 0.70.
Health insurance expansion was associated with a significant reduction in OHCA incidence. Based on this pilot study, further investigation in larger populations is warranted and feasible.
健康保险有诸多益处，包括改善经济保障、增加获得预防性护理的机会以及提升自我感知健康水平。然而，健康保险对主要健康结局的影响尚不清楚。鉴于心脏骤停对过早死亡有重大影响且其对预防性护理可能较为敏感，预防心脏骤停是健康保险的主要潜在益处之一。
我们进行了一项有对照组的前后研究，调查俄勒冈州马尔特诺马县成年居民的院外心脏骤停（OHCA）情况（2015年成年人口为636,000）。评估了围绕《平价医疗法案》实施的两个时间段：2011 - 2012年（“扩张前”）和2014 - 2015年（“扩张后”）。将经历保险扩张的中年人群（45 - 64岁）的OHCA发病率变化与几乎普遍享有持续保险覆盖的老年人群（年龄≥65岁）进行比较。中年个体的OHCA发病率从每10万人102例（95%置信区间：每10万人92 - 113例）降至每10万人85例（95%置信区间：每10万人76 - 94例），P值为0.01。老年人群的OHCA发病率无变化，发病率分别为每10万人275例（95%置信区间：每10万人250 - 300例）和每10万人269例（95%置信区间：每10万人245 - 292例），P值为0.70。
健康保险扩张与OHCA发病率显著降低相关。基于这项试点研究，有必要且可行在更大人群中进行进一步调查。
