Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Birth Defects Res. 2021 May;113(8):644-659. doi: 10.1002/bdr2.1878. Epub 2021 Feb 15.
Data are lacking regarding the insurance status of adults with congenital heart disease (ACHD). We investigated whether the Affordable Care Act (ACA) impacted insurance status among hospitalized ACHD, identified associated sociodemographic factors, and compared coverage to adults with other chronic childhood conditions.
Serial cross-sectional analysis of National Inpatient Sample hospitalizations from 2007 to 2016 was performed for patients 18-64 years old. ACHD were identified using ICD-9/10-CM codes and compared to patients with sickle cell disease (SCD), cystic fibrosis (CF), and the general population. Age was dichotomized as 18-25 years (transition aged) or 26-64 years. Groups were compared by era (pre-ACA [January 2007-June 2010]; early-ACA [July 2010-December 2013], which eliminated pre-existing condition exclusions; and full-ACA [January 2014-December 2016]) using interrupted time series and multivariable Poisson regression analyses.
Overall, uninsured hospitalizations decreased from pre-ACA (12.0%) to full-ACA (8.5%). After full ACA implementation, ACHD had lower uninsured rates than the general hospitalized population (6.0 vs. 8.6%, p < .01), but higher rates than those with other chronic childhood diseases (SCD [4.5%]; CF [1.6%]). Across ACA eras, transition aged ACHD had higher uninsured rates than older patients (8.9 vs. 7.6%, p < .01), and Hispanic patients remained less insured than other groups.
Hospitalized ACHD were better insured than the general population but less insured than those with SCD or CF. Full ACA implementation was associated with improved insurance coverage for all groups, but disparities persisted for transition aged and Hispanic patients. Ongoing evaluation of the effects of insurance and health policy on ACHD remains critical to diminish health disparities.
关于先天性心脏病（ACHD）成人的保险状况数据缺乏。我们调查了《平价医疗法案》（ACA）是否影响了住院 ACHD 的保险状况，确定了相关的社会人口因素，并将其与患有其他慢性儿童疾病的成年人进行了比较。
对 2007 年至 2016 年全国住院患者的连续横断面分析进行了研究，研究对象为 18-64 岁的患者。使用 ICD-9/10-CM 代码识别 ACHD，并将其与镰状细胞病（SCD）、囊性纤维化（CF）和一般人群进行比较。年龄分为 18-25 岁（过渡年龄）或 26-64 岁。使用中断时间序列和多变量泊松回归分析，通过时代（ACA 前[2007 年 1 月至 2010 年 6 月]；早期 ACA[2010 年 7 月至 2013 年 12 月]，消除了先前存在的疾病排除规定；以及全面 ACA[2014 年 1 月至 2016 年 12 月]）比较各组。
总体而言，无保险住院治疗率从 ACA 前（12.0%）降至全面 ACA（8.5%）。在全面实施 ACA 后，ACHD 的无保险率低于一般住院人群（6.0%比 8.6%，p<.01），但高于其他慢性儿童疾病（SCD[4.5%]；CF[1.6%]）。在 ACA 各个时代，过渡年龄段的 ACHD 的无保险率高于老年患者（8.9%比 7.6%，p<.01），而西班牙裔患者的保险率仍低于其他群体。
与一般人群相比，住院 ACHD 的保险状况更好，但与 SCD 或 CF 患者相比，保险状况较差。全面实施 ACA 与所有群体的保险覆盖范围改善有关，但对于过渡年龄段和西班牙裔患者的差异仍然存在。对保险和卫生政策对 ACHD 的影响进行持续评估对于减少健康差距仍然至关重要。
