Fenton David, Kent Johnathan R, Nordgren Rachel, Siamatu Mazuba, Allen Amani, Gleason Lauren J, Landi A Justine, Huisingh-Scheetz Megan, Ferguson Mark K, Madariaga Maria Lucia L
Pritzker School of Medicine University of Chicago Chicago Illinois USA.
Department of Surgery University of Chicago Medicine Chicago Illinois USA.
Health Sci Rep. 2025 Jul 22;8(7):e70791. doi: 10.1002/hsr2.70791. eCollection 2025 Jul.
Frailty is an age-related syndrome associated with poor surgical outcomes, but the impact of insurance payer status on frailty is not fully understood. We sought to evaluate the association between insurance payer status and frailty among thoracic surgery patients.
This retrospective study included all patients undergoing routine frailty screening in a general thoracic surgery clinic at a single center from December 2020 to December 2022. Insurance payers were collected (Medicare, Medicaid, or private). Frailty was measured using the Fried's Frailty Phenotype (FFP) (0: not frail, 1-2: prefrail, 3-5: frail) and the Modified 5-Item Frailty Index (mFI-5) (≥ 2 vs. 0-1). Fisher's Exact and Kruskal-Wallis tests and multivariable logistic regressions were performed. A final sensitivity analysis was conducted to examine the association of insurance and frailty in patients who underwent surgery.
Of the 430 screened patients, 41% (183) were female, median age was 68 (IQR: 62-74), and 48% (207) were non-White. Insurance coverage was 63% (271) Medicare, 15% (64) Medicaid, and 22% (95) private insurance. Of the cohort, 44% (189) of patients underwent subsequent surgery. After adjusting for age, sex, BMI, race/ethnicity, income, smoking status, medications, cancer history, and healthcare utilization, patients with Medicare were more likely to be frail than those with private insurance (FFP: Medicare-OR: 3.17, CI: [1.14-9.72], < 0.05 | mFI-5: OR: 3.40, CI: [1.45-8.55], < 0.01). This association was seen in patients with Medicaid by mFI-5 (OR: 3.35, CI: [1.24-9.51], < 0.05). Furthermore, these findings were consistent with our sensitivity analysis.
Publicly insured surgical patients are more likely to be frail than those privately insured. The etiology of this disparity is multifactorial and may be a result of healthcare inaccessibility, limitations of coverage, and lower socioeconomic status. Future policy-based interventions to address social determinants of health may reduce insurance disparities.
衰弱是一种与手术预后不良相关的年龄相关综合征，但保险支付者身份对衰弱的影响尚未完全明确。我们旨在评估胸外科手术患者的保险支付者身份与衰弱之间的关联。
这项回顾性研究纳入了2020年12月至2022年12月在单一中心的普通胸外科诊所接受常规衰弱筛查的所有患者。收集保险支付者信息（医疗保险、医疗补助或私人保险）。使用弗里德衰弱表型（FFP）（0：非衰弱，1 - 2：衰弱前期，3 - 5：衰弱）和改良的5项衰弱指数（mFI - 5）（≥2与0 - 1）来衡量衰弱程度。进行了费舍尔精确检验、克鲁斯卡尔 - 沃利斯检验和多变量逻辑回归分析。进行了最终的敏感性分析，以检验接受手术患者的保险与衰弱之间的关联。
在430名接受筛查的患者中，41%（183名）为女性，中位年龄为68岁（四分位间距：62 - 74岁），48%（207名）为非白人。保险覆盖情况为63%（271名）医疗保险、15%（64名）医疗补助和22%（95名）私人保险。在该队列中，44%（189名）患者接受了后续手术。在调整年龄、性别、体重指数、种族/族裔、收入、吸烟状况、用药情况、癌症病史和医疗服务利用情况后，医疗保险患者比私人保险患者更易衰弱（FFP：医疗保险 - 比值比：3.17，置信区间：[1.14 - 9.72]，<0.05 | mFI - 5：比值比：3.40，置信区间：[1.45 - 8.55]，<0.01）。通过mFI - 5在医疗补助患者中也观察到了这种关联（比值比：3.35，置信区间：[1.24 - 9.51]，<0.05）。此外，这些发现与我们的敏感性分析结果一致。
公共保险的手术患者比私人保险患者更易衰弱。这种差异的病因是多因素的，可能是医疗服务可及性差、保险覆盖范围有限以及社会经济地位较低的结果。未来基于政策的干预措施以解决健康的社会决定因素可能会减少保险差异。
