The Cost of Instability: The Effects of Family, Work, and Welfare Change on Low-Income Women’s Health Insurance Status

Objective For colon cancer patients, one goal of health insurance is to improve access to screening that leads to early detection, early-stage diagnosis, and polyp removal, all of which results in easier treatment and better outcomes. We examined associations among health insurance status, mode of detection (screen detection vs symptomatic presentation), and stage at diagnosis (early vs late) in a diverse sample of patients recently diagnosed with colon cancer from the Chicago metropolitan area. Methods Data came from the Colon Cancer Patterns of Care in Chicago study of racial and socioeconomic disparities in colon cancer screening, diagnosis, and care. We collected data from the medical records of non-Hispanic Black and non-Hispanic White patients aged ≥50 and diagnosed with colon cancer from October 2010 through January 2014 (N = 348). We used logistic regression with marginal standardization to model associations between health insurance status and study outcomes. Results After adjusting for age, race, sex, and socioeconomic status, being continuously insured 5 years before diagnosis and through diagnosis was associated with a 20 (95% CI, 8-33) percentage-point increase in prevalence of screen detection. Screen detection in turn was associated with a 15 (95% CI, 3-27) percentage-point increase in early-stage diagnosis; however, nearly half (47%; n = 54) of the 114 screen-detected patients were still diagnosed at late stage (stage 3 or 4). Health insurance status was not associated with earlier stage at diagnosis. Conclusions For health insurance to effectively shift stage at diagnosis, stronger associations are needed between health insurance and screening-related detection; between screening-related detection and early stage at diagnosis; or both. Findings also highlight the need to better understand factors contributing to late-stage colon cancer diagnosis despite screen detection.

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Disparities in neonatal abstinence syndrome and health insurance status: A statewide study using non–claims real‐time surveillance data

Paediatric and Perinatal Epidemiology ◽

10.1111/ppe.12728 ◽

2020 ◽

Author(s):

Amna Umer ◽

Christa Lilly ◽

Candice Hamilton ◽

Janine Breyel ◽

Lindsay Allen ◽

...

Keyword(s):

Health Insurance ◽

Real Time ◽

Surveillance Data ◽

Neonatal Abstinence Syndrome ◽

Insurance Status ◽

Abstinence Syndrome ◽

Health Insurance Status

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Health Insurance Coverage before and after the Affordable Care Act in the USA

Sci ◽

10.3390/sci3020025 ◽

2021 ◽

Vol 3 (2) ◽

pp. 25

Author(s):

Jesse Patrick ◽

Philip Q. Yang

Keyword(s):

Health Insurance ◽

National Health ◽

Affordable Care Act ◽

The United States ◽

Insurance Status ◽

Health Insurance Status ◽

Full Implementation ◽

Before And After ◽

The Affordable Care Act ◽

Partial Implementation

The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, the foreign-born, Asians, and other races had a greater probability of gaining health insurance after the ACA than before the ACA; however, the odds of obtaining health insurance for Hispanics and the impoverished rose slightly during the partial implementation of the ACA, but somewhat declined after the full implementation of the ACA starting in 2014. These findings should be taken into account by the U.S. Government in deciding the fate of the ACA.

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Association of Health Insurance Status with Outcomes of Sepsis in Adult Patients: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115777 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5777

Author(s):

Gaon-Sorae Wang ◽

Kyoung-Min You ◽

You-Hwan Jo ◽

Hui-Jai Lee ◽

Jong-Hwan Shin ◽

...

Keyword(s):

Health Insurance ◽

Propensity Score ◽

Hospital Mortality ◽

Cohort Analysis ◽

Adult Patients ◽

Multivariate Logistic Regression Model ◽

Insurance Status ◽

Matched Cohort ◽

Health Insurance Status ◽

Significant Difference

(1) Background: Sepsis is a life-threatening disease, and various demographic and socioeconomic factors affect outcomes in sepsis. However, little is known regarding the potential association between health insurance status and outcomes of sepsis in Korea. We evaluated the association of health insurance and clinical outcomes in patients with sepsis. (2) Methods: Prospective cohort data of adult patients with sepsis and septic shock from March 2016 to December 2018 in three hospitals were retrospectively analyzed. We categorized patients into two groups according to their health insurance status: National Health Insurance (NHI) and Medical Aid (MA). The primary end point was in-hospital mortality. The multivariate logistic regression model and propensity score matching were used. (3) Results: Of a total of 2526 eligible patients, 2329 (92.2%) were covered by NHI, and 197 (7.8%) were covered by MA. The MA group had fewer males, more chronic kidney disease, more multiple sources of infection, and more patients with initial lactate > 2 mmol/L. In-hospital, 28-day, and 90-day mortality were not significantly different between the two groups and in-hospital mortality was not different in the subgroup analysis. Furthermore, health insurance status was not independently associated with in-hospital mortality in multivariate analysis and was not associated with survival outcomes in the propensity score-matched cohort. (4) Conclusion: Our propensity score-matched cohort analysis demonstrated that there was no significant difference in in-hospital mortality by health insurance status in patients with sepsis.

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