Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, Florida, USA.
Department of Health Outcomes and Biomedical Informatics, College of Public Health and Health Professions, University of Florida, 2004 Mowry Road, Gainesville, Florida, USA.
Int J Qual Health Care. 2019 Jun 1;31(5):325-330. doi: 10.1093/intqhc/mzy175.
To investigate the independent contribution of insurance status toward the risk of diagnosis of specific clinical comorbidities for individuals admitted to intensive care unit (ICU).
Retrospective analysis of secondary database.
Ten years of public de-identified ICU electronic medical records from a large hospital in USA.
Patients (18-65 years old) who had private insurance or no insurance were extracted from the database.
Independent association of insurance status (uninsured vs. privately insured) with the risk of diagnosis of specific clinical comorbidities.
Among 14 268 (from 11 753 patients) admissions to ICU between 2001 and 2012, 96% of them were covered by private insurance. Patients with private insurance had higher proportion of females, married, White race, longer ICU stay and more procedures during stay, and fewer deaths. A lower CCI was observed in uninsured patients. At multivariable analysis, uninsured patients had higher odds of death and of admissions for accidental falls, substance or alcohol abuse.
Patients with no insurance coverage were at higher risk of death and of admission for physical and substance-related injury. We did not observe a higher risk for acute life-threatening diseases such as myocardial infarction or kidney failure. The lower CCI observed in the uninsured may be explained by under diagnosis or voluntary withdrawal from coverage in the pre-Affordable Care Act era. Replication of findings is warranted in other populations, among those with government-subsidized insurance and in the procedure/prescription domains.
研究保险状况对入住重症监护病房（ICU）患者特定临床合并症诊断风险的独立影响。
二次数据库的回顾性分析。
来自美国一家大医院的 10 年公开去识别 ICU 电子病历数据库。
从数据库中提取了有私人保险或无保险的 18-65 岁患者。
保险状况（无保险与私人保险）与特定临床合并症诊断风险的独立关联。
在 2001 年至 2012 年间 14268 次（来自 11753 名患者）入住 ICU 的患者中，96%的患者有私人保险。有私人保险的患者中女性、已婚、白种人、ICU 住院时间更长、住院期间接受的程序更多、死亡人数更少。无保险患者的 CCI 较低。多变量分析显示，无保险患者死亡和因意外跌倒、物质或酒精滥用而住院的风险更高。
无保险覆盖的患者死亡和因身体和物质相关损伤而住院的风险更高。我们没有观察到与急性危及生命的疾病（如心肌梗死或肾衰竭）相关的更高风险。无保险患者观察到的较低 CCI 可能是由于在平价医疗法案之前的时期漏诊或自愿退出保险范围所致。在其他人群、有政府补贴保险的人群以及程序/处方领域，需要进行复制研究以验证这些发现。
