Division of Vascular Surgery, University of Arizona College of Medicine, Tucson, AZ.
University of Arizona College of Medicine, Tucson, AZ.
Ann Vasc Surg. 2023 Oct;96:284-291. doi: 10.1016/j.avsg.2023.03.015. Epub 2023 Apr 5.
Peripheral artery disease (PAD) is linked with an increased risk of lower extremity amputation and multiple socioeconomic factors attenuate this risk. Prior studies have demonstrated increased rates of amputation in PAD patients with suboptimal or no insurance coverage. However, the impact of insurance loss in PAD patients with pre-existing commercial insurance coverage is unclear. In this study, we evaluated the outcomes of PAD patients who lose commercial insurance coverage.
The Pearl Diver all-payor insurance claims database was used to identify adult patients (>18 years) with a PAD diagnosis from 2010 to 2019. The study cohort included patients with pre-existing commercial insurance and at least 3 years continuous enrollment after diagnosis of PAD. Patients were stratified based on whether they had an interruption of commercial insurance coverage over time. Patients who transitioned from commercial insurance to Medicare and other government-sponsored insurance during follow up were excluded. Adjusted comparison (1:1 ratio) was performed using propensity matching for age, gender, the Charlson Comorbidity Index (CCI), and relevant comorbidities. The main outcomes were major amputation and minor amputation. Cox proportional hazards ratios and Kaplan-Meier estimate were used to examine the association between loss of insurance and outcomes.
Among the 214,386 patients included, 43.3% (n = 92,772) had continuous commercial insurance coverage and 56.7% (n = 121,614) had interruption of coverage (transition to uninsured or Medicaid coverage) during follow up. In the crude cohort and matched cohort, interruption of coverage was associated with lower major amputation-free survival on Kaplan Meier estimate (P < 0.001). In the crude cohort, interruption of coverage was associated with 77% increased risk of major amputation (OR 1.77, 95% CI 1.49-2.12) and a 41% high risk of minor amputation (OR 1.41, 95% CI 1.31-1.53). In the matched cohort, interruption of coverage was associated with 87% increased risk of major amputation (OR 1.87, 95% CI 1.57-2.25) and a 104% increased risk of minor amputation (OR 1.47, 95% CI 1.36-1.60).
Interruption of insurance coverage in PAD patients with pre-existing commercial health insurance was associated with increased risks of lower extremity amputation.
外周动脉疾病（PAD）与下肢截肢风险增加有关，多种社会经济因素会降低这种风险。先前的研究表明，在没有或保险覆盖不足的 PAD 患者中，截肢率更高。然而，对于具有先前商业保险的 PAD 患者，保险损失的影响尚不清楚。在这项研究中，我们评估了失去商业保险覆盖的 PAD 患者的结局。
使用 Pearl Diver 全支付者保险索赔数据库，从 2010 年到 2019 年，确定患有 PAD 的成年患者（>18 岁）。研究队列包括患有先前商业保险且在 PAD 诊断后至少有 3 年连续参保的患者。根据他们是否中断商业保险覆盖情况对患者进行分层。在随访期间从商业保险转为医疗保险和其他政府赞助保险的患者被排除在外。使用倾向评分匹配对年龄、性别、Charlson 合并症指数（CCI）和相关合并症进行了调整比较（1:1 比例）。主要结局是主要截肢和次要截肢。使用 Cox 比例风险比和 Kaplan-Meier 估计来检查保险损失与结局之间的关联。
在纳入的 214386 名患者中，43.3%（n=92772）有连续的商业保险覆盖，56.7%（n=121614）在随访期间中断了覆盖（转为无保险或医疗补助覆盖）。在未校正队列和匹配队列中，Kaplan-Meier 估计中断覆盖与较低的主要截肢无生存相关（P<0.001）。在未校正队列中，中断覆盖与主要截肢风险增加 77%相关（OR 1.77，95%CI 1.49-2.12），与次要截肢风险增加 41%相关（OR 1.41，95%CI 1.31-1.53）。在匹配队列中，中断覆盖与主要截肢风险增加 87%相关（OR 1.87，95%CI 1.57-2.25），与次要截肢风险增加 104%相关（OR 1.47，95%CI 1.36-1.60）。
在具有先前商业健康保险的 PAD 患者中，中断保险覆盖与下肢截肢风险增加相关。
