Gupta Rajeev, Makkar Jitender S, Sharma Sanjeev K, Agarwal Ansh, Sharma Krishna K, Bana Ajeet, Kasliwal Atul, Sidana Sanjeev K, Degawat Prem Ratan, Bhagat Kush K, Natani Vishnu, Khedar Raghubir S, Sharma Samin K
Departments of Cardiology, Eternal Heart Care Centre and Research Institute, Jaipur, 302017, India.
Departments of Internal Medicine, Eternal Heart Care Centre and Research Institute, Jaipur, 302017, India.
Int J Cardiol Cardiovasc Risk Prev. 2022 Aug 13;14:200146. doi: 10.1016/j.ijcrp.2022.200146. eCollection 2022 Sep.
Coronary artery disease (CAD) related hospitalization and interventions are associated with catastrophic out-of-pocket health expenditure in India. To evaluate differences in risk factors, disease severity, management and outcomes in uninsured vs insured CAD patients we performed a study.
Successive CAD patients who underwent percutaneous intervention (PCI) at our centre were enrolled from January 2018 to June 2021. Clinical, angiographic and intervention data were periodically uploaded in the American College of Cardiology CathPCI platform. Descriptive statistics are reported.
4672 CAD patients (men 3736, women 936) were included; uninsured were 2166 (46%), government insurance was in 1635 (36%) and private insurance in 871 (18%). Mean age was 60.1 ± 11 years, uninsured <50y were 21.6% vs 14.0% and 20.3% with government and private insurance. Among the uninsured prevalence of raised total and non-HDL cholesterol, any tobacco use, ST-elevation myocardial infarction (STEMI) and ejection fraction <30% were more (p < 0.01). In the STEMI group (n = 1985), rates of primary PCI were the highest in those with private insurance (38.7%) compared to others. Multivessel stenting (≥2 stents) was more among the insured patients. Median length of hospital stay was similar in the three groups. In-hospital mortality was slightly more in the uninsured (1.43%), compared to government (0.88) and privately insured (0.82) (p = 0.242). The cost of hospitalization and procedures was the highest among uninsured (US$ 2240, IQR 1877-2783) compared to government (US$ 1977, IQR 1653-2437) and privately insured (US$ 2013, IQR 1668-2633) (p < 0.001).
Uninsured CAD patients in India are younger with more risk factors, acute coronary syndrome, STEMI, multivessel disease and coronary stenting compared to those with government or private insurance. The uninsured bear significantly greater direct costs with slightly greater mortality.
在印度，冠心病（CAD）相关住院治疗和干预与灾难性的自付医疗费用有关。为评估未参保与参保CAD患者在危险因素、疾病严重程度、治疗及结局方面的差异，我们开展了一项研究。
连续纳入2018年1月至2021年6月在我院中心接受经皮冠状动脉介入治疗（PCI）的CAD患者。临床、血管造影及介入治疗数据定期上传至美国心脏病学会CathPCI平台。报告描述性统计结果。
共纳入4672例CAD患者（男性3736例，女性936例）；未参保者2166例（46%），政府医保覆盖者1635例（36%），私人医保覆盖者871例（18%）。平均年龄为60.1±11岁，未参保者中年龄<50岁者占21.6%，而政府医保和私人医保覆盖者中这一比例分别为14.0%和20.3%。在未参保者中，总胆固醇及非高密度脂蛋白胆固醇升高、任何形式的烟草使用、ST段抬高型心肌梗死（STEMI）及射血分数<30%的患病率更高（p<0.01）。在STEMI组（n=1985）中，私人医保覆盖者的直接PCI率最高（38.7%），高于其他组。多支血管支架置入（≥2枚支架）在参保患者中更为常见。三组患者的住院中位时长相似。未参保者的院内死亡率略高于政府医保覆盖者（1.43%对0.88%）和私人医保覆盖者（0.82%）（p=0.242）。未参保者的住院及治疗费用最高（2240美元，四分位数间距1877 - 2783美元），高于政府医保覆盖者（1977美元，四分位数间距1653 - 2437美元）和私人医保覆盖者（2013美元，四分位数间距1668 - 2633美元）（p<0.001）。
与政府医保或私人医保覆盖的CAD患者相比，印度未参保的CAD患者更年轻，危险因素更多，急性冠状动脉综合征、STEMI、多支血管病变及冠状动脉支架置入的比例更高。未参保者承担的直接费用显著更高且死亡率略高。
