Abstract WMP93: Uninsured Patients have Longer Hospital Stays and are Less Likely to Receive Rehab than Insured Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Daniel Korya ◽  
Kendra Drake ◽  
Bruce Coull
Keyword(s):  
Social Services ◽  
Private Insurance ◽  
Functional Independence ◽  
University Hospital ◽  
Insurance Status ◽  
Uninsured Patients ◽  
The Us ◽  
The Mean ◽  
Insured Patients

Background: In 2010 the estimated direct and indirect cost of stroke was $53.9 billion. The long-term burden to society is thought to be much more costly. Whether or not this sum can be reduced has been a subject of great debate. Recently, healthcare reform has been a priority for policy makers with health insurance as a prevailing issue. We examined the healthcare records of patients in the US who presented with stroke symptoms in a 10-year period from 2001-2011, and compared them to patients in the state of Arizona as well as our University Hospital in the same time period. We then looked for differences in the cost of stroke with regard to variations in insurance status. Methods: The records of 978,813 patients with stroke symptoms in the US from January 2001 through December 2011 were compared with 18,875 Arizona (AZ) patients. This data was evaluated and compared with data obtained from the records of 1,123 patients admitted to the University Medical Center (UMC), and separated by insurance status, discharge location and length of stay (LOS) for different stroke subtypes. The information was gathered from the get with the guidelines stroke database and only included hospitals that reported their information. Results: The mean LOS for stroke patients in the US, AZ and UMC were: 5.25 days, 4.69 and 4.75 days, respectively. When separated by insurance status, the mean LOS for patients at UMC with Medicare was 4.27 days (n=470), for Medicaid it was 6.17 days (n=150) and 5.13 days (n=464) for private insurance. Compared with insured patients, uninsured patients had a LOS of 8.18 days (n=39; p=.001). Uninsured patients were discharged home without rehab 24.4% of the time compared with only 8.8% of insured patients (p=.001), even though 93.5% of uninsured patients were considered for rehab. Conclusion: Uninsured patients had a LOS that was 3.3 days longer than insured patients and had an estimated 72% higher cost of hospitalization. Uninsured patients were almost 3 times less likely than insured patients to be discharged with rehab, and consequently were less likely to achieve long-term functional independence. Ultimately, the price of stroke in the uninsured is paid for by taxpayers, since these patients will require social services granted by the government for disability.

Survival Disparities By Insurance Type For Patients With Non-Hodgkin Lymphoma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1737-1737
Author(s):  
Dianne Pulte ◽  
Hermann Brenner ◽  
Lina Jansen
Keyword(s):  
Hodgkin Lymphoma ◽  
Private Insurance ◽  
Relative Survival ◽  
Complete Analysis ◽  
Insurance Status ◽  
Age Group ◽  
Seer Database ◽  
Uninsured Patients ◽  
Non Hodgkin Lymphoma ◽  
The Us

Abstract Background Lack of access to health insurance is known to be a poor prognostic indicator in many conditions. Here, we examine survival in patients with non-Hodgkin lymphoma (NHL) in the US by insurance status, including no insurance, Medicaid only, and other insurance (private or Medicare) to explore the extent of this effect in NHL patients. Methods Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Information regarding patients' insurance status became available in the SEER database in the most recent dataset and is available from 2007 on. The SEER17 database was used to provide the maximum number of patients. Period analysis was performed to estimate 1-year survival and complete analysis was used to estimate 3-year survival. Patients with a diagnosis of NHL diagnosed between 2007 and 2010 with follow up available through 2010 were included. Because patients over age 65 are almost all qualified for Medicare, patients age 15-64 were evaluated. Because NHL is a heterogeneous condition with subtypes having varied survival, we examined survival in diffuse large B-cell lymphoma (DLBCL) specifically as well. Results Relatively few patients were listed as uninsured, with less than 10% of patients being listed as uninsured in the SEER database (as opposed to over 20% in the US population at large for patients under age 65.) Initial age stratification showed that there was very little difference in survival for patients age 45-64 and therefore these patients were considered as a single age category to improve statistical power. For NHL overall, survival was much lower for both uninsured patients and patients with Medicaid as compared to patients with other forms of insurance at both 1- and 3-years and for each age group examined (Table). For patients age 15-44, 1-year relative survival was 15.1 and 17.7 percentage points lower for uninsured and Medicaid patients, respectively, than for patients with other forms of insurance. The differences for 3-year survival were 18.8 and 22.9% units, respectively, uninsured and Medicaid patients. Three year relative survival for patients age 15-44 without insurance was 67.8%. For comparison, 3-year survival for the same age group in 1978-80 was 69%. A similar pattern was seen for patients with DLBCL, with survival being higher for patients with private insurance compared with patients who were uninsured or insured by Medicaid. One year survival estimates were 12.8 and 13.4% units lower, respectively, for uninsured patients ages 15-44 and 45-64 as compared to patients with private insurance or Medicare. Three year survival estimates were 14.2 and 14.1% units higher, respectively, for the same comparison. Conclusions Lack of insurance was associated with severe compromise of survival for patients with lymphoma. Survival is much lower for patients with Medicaid as opposed to other forms of insurance, possibly because of the extreme poverty required for Medicaid eligibility in most states, which may compromise patients' ability to be compliant with care. Furthermore, patients with Medicaid may have only been granted Medicaid after the diagnosis of cancer and been previously uninsured, which may be a risk for presentation at a later stage of disease. Further evaluation of the reasons for the low survival for patients with Medicaid and implementation of comprehensive coverage for medical care for uninsured patients are urgently needed to reduce this disparity. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Impact of Insurance Status on the Day of Admission and Clinical Outcome on Acute Myeloid Leukemia (AML)Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2274-2274
Author(s):  
Bilal Ahmad ◽  
Hossein Maymani ◽  
Haseeb Saeed ◽  
Mohamad Khawandanah ◽  
Samer A Srour ◽  
...  
Keyword(s):  
Overall Survival ◽  
Myeloid Leukemia ◽  
Private Insurance ◽  
P Value ◽  
Insurance Status ◽  
Uninsured Patients ◽  
Public Insurance ◽  
Group 2 ◽  
Insured Patients ◽  
Group 1

Abstract Background: In patients with acute myeloid leukemia (AML), insurance status has not been demonstrated to adversely impact outcomes. However, insurance status appears to be an independent factor in healthcare utilization. University of Oklahoma Health Sciences Center (OUHSC) is the main tertiary hospital in the State of Oklahoma treating patients with acute leukemia. We hypothesized that treatment patterns might be different between the insured and uninsured patients. We hereby attempt to analyze the association between insurance status, week day of admission and outcomes. Methods: We retrospectively analyzed patients from January 2000 to June 2012 diagnosed with AML over 18 years of age, who were treated at OUHSC with induction chemotherapy. Patients were divided into two groups: Group 1 included patients who were admitted on weekdays (Monday-Thursday) and group 2 included patients admitted on weekends (Friday-Sunday). Patients were also sub-classified as having private insurance, public insurance (Medicaid and Medicare) or no insurance. Primary outcomes were overall survival at follow up (OS), complete remission (CR) and Relapse. Chi-Square analysis was utilized to assess if day of admission and insurance status was related to OS, CR and Relapse. Cox Proportional hazards model was used to measure association of insurance status, day of admission and their interaction and Kaplan Meir Survival curves were used to estimate survival rates for day of admission by insurance status. Results: We analyzed total of 161 patients, 157 met inclusion criteria with 69 (44%) having public insurance, 58 (37%) with private insurance and 30 (19%) were uninsured. Group 1 with 94 (60%) patients was admitted on weekdays (Monday–Thursday), and group 2 with 63 (40%) patients was admitted on weekend (Friday-Sunday). The median age at diagnosis was 49 years, 63.7% male 36.3% female. 77.0% white, 10.6% African American, 6.2% Native American and 3.7% Hispanic. We found a significant interaction between insurance status and day of admission, 63% of uninsured patients being admitted on weekend (Fri-Sun) with (p-value=0.0292). When we stratified patients by insurance status there was no difference in survival outcomes for uninsured patients based on day of admission. However, for patients with insurance who were admitted on weekdays Mon-Thurs (Group 1) had a hazard ratio (HR) of death 0.487 relative to those on weekends Fri-Sun (Group 2) (p=0.0238). Median overall survival (OS) for uninsured patients in (Group 2) was 147.5 days (95% CI=79-252) as compare to insured patients in (Group 1) 252 days (95% CI=116-459) with a P value 0.0182. The proportion of patients achieving CR did not differ by day of admission (p=0.3275) and insurance type (0.5678). Relapse was not associated with day of admission (p=0.2284) or by insurance type (p=0.4057). Conclusions: For the patients with the diagnosis of AML who presented to our institution, there was a noticeable trend of uninsured patients being admitted over the weekend. The overall survival was lower for the uninsured patients who were admitted on the weekend as compare to the insured patients who were admitted on weekdays. This trend is both noteworthy and significant and due to its possible impact on standard of care warrants further investigation. Disclosures No relevant conflicts of interest to declare.

Insurance status and survival in diffuse large B-cell lymphoma: A National Cancer Database study before and after the Affordable Care Act.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6539-6539
Author(s):  
Antoine N Saliba ◽  
Xavier Andrade-Gonzalez ◽  
Paul Joseph Hampel ◽  
Jithma P. Abeykoon ◽  
Allison Bock ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Cell Lymphoma ◽  
Private Insurance ◽  
B Cell Lymphoma ◽  
Insurance Status ◽  
Newly Diagnosed ◽  
Uninsured Patients ◽  
Large B Cell Lymphoma ◽  
Before And After ◽  
Insured Patients

6539 Background: The impact of insurance status on survival in diffuse large B‐cell lymphoma (DLBCL), the most common aggressive lymphoma, has not been evaluated after the implementation of the Affordable Care Act (ACA). The aim of this study is to compare overall survival (OS) in patients across insurance status groups and in the periods before and after the ACA. Methods: Adult patients with newly diagnosed DLBCL were identified from the National Cancer Database. The analysis was restricted to patients 64 years of age or younger as most patients 65 years or older are eligible for Medicare under the ACA. The 2004-2017 period was chosen to represent the immunochemotherapy era preceding and following the ACA. Logistic regression was used to explore associations between abstracted variables and insurance status groups. The Kaplan-Meier method and Cox proportional hazards model were used for survival analysis. Results: 93,692 adults (age < 64 years) with newly diagnosed DLBCL and known insurance status were identified (41.3% female, median age 54 years [range: 18 – 64], 81.8% White and 12.1% Black). 7,211 (7.7%) patients were uninsured, 64,744 (69.1%) had private insurance, 11,936 (12.7%) had Medicaid, and 9,801 (10.5%) had Medicare. When compared to insured patients (private insurance, Medicaid or Medicare), uninsured patients were more likely to have a median household outcome of < $38,000 [OR 1.93 (95% CI 1.79-2.07)], less likely to receive chemotherapy [OR 0.69 (0.64-0.77)], more likely to be male [OR 1.14 (1.07-1.21)], more likely to be non-White [OR 1.30 (1.20-1.40], and more likely to present with stage III or IV disease [OR 1.24 (1.16-1.32)]. Uninsured patients had an inferior OS [HR 1.21 (95% CI 1.15-1.27)] when compared to insured patients after adjustment for baseline comorbidity (Charlson-Deyo score ≥2), advanced stage, treatment with chemotherapy, and sociodemographic factors including sex, age, race, household income, facility type (academic/community), and location (urban/rural). With a median follow-up time of 14.8 years (95% CI 14.6-not reached), median OS was lower in uninsured patients [13.4 years (12.3-not reached) vs 14.8 years (14.7-not reached); p < 0.0001]. Despite the lack of major changes in DLBCL therapies, a diagnosis after the implementation of the ACA (in 2010 or later) was associated with a superior OS when compared with the outcomes of patients diagnosed in 2010 or earlier [HR 0.93 (95% CI 0.90-0.95)]. Similarly, five-year OS was superior in the insured group [HR 0.93 (95% CI 0.89-0.96)]. Conclusions: Uninsured patients with DLBCL and < 64 years old had inferior OS when compared with insured patients, and uninsured status emerged as an independent risk factor for inferior OS. Our data highlight the independent effect of insurance disparities - a potential indicator of variations in access to health care - on survival in DLBCL.

scholarly journals Survival Outcomes for US and Canadian Patients Diagnosed with Hodgkin Lymphoma before and after Brentuximab Vedotin Approval for Relapsed/Refractory Disease: A Retrospective Cohort Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 3-4
Author(s):  
Gwynivere A Davies ◽  
John E. Orav ◽  
Kristen Brantley
Keyword(s):  
Brentuximab Vedotin ◽  
Insurance Status ◽  
Uninsured Patients ◽  
Risk Of Death ◽  
Period 2 ◽  
Fda Approval ◽  
The Us ◽  
Insured Patients ◽  
Privately Insured

Background: Insurance status impacts access and survival for cancer patients within mixed healthcare systems, such as the US (Walker et al., 2014). Universal healthcare, as in Canada, provides broad coverage, though new drug funding is delayed for financial evaluations given escalating costs of oncologic therapies. Brentuximab Vedotin (BV) was the first FDA approved medication (2011) for Hodgkin lymphoma (HL) since 1977, with a 75% response rate and median overall survival (OS) 40.5 months in patients relapsing post transplant, compared to OS 10.5 to 27.6 months with prior therapies (Chen et al., 2016). Approximately 20% of HL patients develop refractory/relapsed disease, and most proceed to transplant; a further 50% relapse however, thus effective therapy is critical. Given the cost ($232 320 CAD per course; pCODR, 2018), an extensive cost-efficacy analysis was completed in Canada prior to funding, leading to a 3 year delay compared to FDA approval and US funding. We therefore compared OS for US and Canadian patients diagnosed with HL pre/post FDA approval of BV for post-transplant relapse, hypothesizing that 1) survival differences within the US according to insurance would be present and widen after approval and 2) a survival gap would emerge between privately insured US vs. Canadian patients. Methods: A retrospective cohort study was performed of patients 16-64 years diagnosed with classical HL in 2007-2010 (period 1) or 2011-2014 (period 2) from the US SEER and Canadian Cancer Registry (CCR), with vital status updated to November 2016 and December 31, 2014 respectively. A surrogate date for access (FDA approval) was used as neither dataset captures chemotherapy. Exclusion criteria included missing histology, follow-up or insurance data, or post-mortem diagnosis. Log-rank test and Kaplan-Meier analysis compared OS (primary outcome) between groups: in period 2 vs. 1 by US insurance status (aim 1) and including a Canadian/universal category (aim 2). Analysis was performed within each dataset to allow for maximal adjustment utilizing Cox proportional hazards by covariates (age, gender, insurance status, stage, lymphoma subtype, race, ethnicity, marital status within SEER; age, gender, subtype within CCR), then merged using common variables. Secondary outcomes examined 36-month OS (longest calculable given censoring dates) to compare the direction and degree of change in survival between time periods. Results: 12,003 US and 4,210 Canadian patients were included. Demographics were similar, though follow up was shorter for the latter due to censoring date. US patients demonstrated improved survival (crude HR=0.90 (95%CI 0.80-1.02), adjusted HR=0.80 (95%CI 0.71-0.91)), between periods. Canadian patients had a similar reduced risk of death between periods, though this became statistically insignificant after adjustment (crude HR=0.72 (95%CI 0.54-0.95), adjusted HR=0.77 (95%CI 0.59-1.02)). Comparing all patients by country (periods combined) demonstrated a non-significant increased crude risk of death in US vs. Canadian patients (HR 1.13, p=0.059, 95% CI 1.00-1.27). Stratifying US patients by insurance demonstrated stable OS for privately insured, significantly improved OS for Medicaid and non-significantly worse survival for uninsured patients, demonstrating divergence by time likely not solely due to BV access. No difference in OS improvement occurred between periods for privately insured vs. universal patients. In an adjusted model including time period, compared with universal there was increased risk for both uninsured (HR 1.80, p&lt;0.0001, 95% CI 1.46-2.20) and Medicaid patients (HR 2.36, p&lt;0.0001, 95% CI 2.02-2.76), and reduced risk in privately insured patients (HR 0.87, p=0.044, 95% CI 0.77-1.00). Unadjusted 36-month OS quantified divergence according to insurance, with a large (+7.4%) and small (+2.4%) improvement in Medicaid and universal patients respectively, no change in privately insured and worse survival (-4.1%) for uninsured patients. Conclusions: HL survival was worse for Medicaid/uninsured compared to privately/universally insured patients, however all had stable or improved survival in period 2 except uninsured patients. No difference in change between periods for privately or universally insured patients occurred due to delayed access, however robust datasets capturing chemotherapy and comorbidities are needed. Disclosures Davies: Novartis: Honoraria; TEVA: Honoraria.

Long term results of accelerated corneal collagen cross-linking in pediatric keratoconus

2021 ◽  
pp. 112067212110183
Author(s):  
Yasin Cinar ◽  
Cagla Cilem Han ◽  
Alparslan Sahin ◽  
Zeba A Syed
Keyword(s):  
Visual Acuity ◽  
Corneal Thickness ◽  
University Hospital ◽  
Long Term Results ◽  
Cross Linking ◽  
Distance Visual Acuity ◽  
The Mean ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Purpose: To evaluate the long term visual, refractive, and corneal tomographic outcomes of epithelium-off accelerated corneal collagen cross-linking (ACXL) in the management of pediatric keratoconus (KC). Methods: This retrospective study included patients under 18 years old with progressive KC who underwent ACXL between 2012 and 2019 at Dicle University Hospital. Complete ophthalmic examination was performed including uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Evaluations were performed preoperatively and at 6 months intervals postoperatively. Results: Forty-nine eyes of 49 patients were included in the study. The mean age of patients at the time of ACXL was 14.2 ± 1.8 (range: 9.5–17.3) years. Mean follow up was 4.61 ± 1.90 (range: 2.0–8.1) years. The mean LogMAR UDVA improved from 0.94 ± 0.41 to 0.81 ± 0.43, 0.69 ± 0.41, and 0.67 ± 0.33 after 1, 3, and 5 years respectively ( p = 0.001). The mean LogMAR CDVA improved from 0.58 ± 0.36 to 0.46 ± 0.31, 0.34 ± 0.23, and 0.39 ± 0.27 after 1, 3, and 5 years respectively ( p = 0.015). The mean refractive cylinder improved significantly from 6.01 ± 2.07 diopters (D) to 5.46 ± 1.87, 5.38 ± 2.18, and 5.02 ± 2.31 D after 1, 3, and 5 years respectively ( p = 0.005). As compared to preoperative values, steep keratometry and maximum keratometry were not significantly different ( p = 0.805 and 0.448, respectively) following ACXL, while flat keratometry significantly improved after ACXL ( p = 0.012). Although central corneal thicknesses decreased significantly ( p = 0.029), the decrease in thinnest corneal thickness was not statistically significant ( p = 0.205). Conclusion: Epithelium-off ACXL seems to be effective for halting KC progression with long term clinical benefits in pediatric patients.

Survival Outcome and Insurance Status Among Hodgkin's Lymphoma (HL) Patients: Data from SEER 2007-2014

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 915-915
Author(s):  
Qian Wang ◽  
Changchuan Jiang ◽  
Yaning Zhang ◽  
Stuthi Perimbeti ◽  
Prateeth Pati ◽  
...  
Keyword(s):  
Cox Regression ◽  
Conflicts Of Interest ◽  
Age Groups ◽  
Survival Outcome ◽  
Disease Stage ◽  
Insurance Status ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Us ◽  
Insured Patients

Abstract Introduction: Previous studies have shown that uninsured and Medicaid patients had higher morbidity and mortality due to limited access to healthcare. Disparities in cancer-related treatment and survival outcome by different insurance have been well established (Celie et al. J Surg Oncol.,2017). There are approximately 8,260 newly diagnosed HL cases in the US yearly (Master et al. Anticancer Res.2017). Therefore, we aim to investigate the variation of survival outcome and insurance status among HL patients. Methods: We extracted data from the US National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) 18 program. HL patients who were diagnosed from 2007-2014 were included. Demographic information including age, sex, race, annual household income, education and insurance were also collected. Insurance includes uninsured, insured and any Medicaid. Race/ethnicity includes white, black and other (including American Indian/AK native, Asian/Pacific Islander). HL is categorized by using International Classification of Disease for Oncology (ICD-O-3) into classical HL NOS (CHL NOS), nodular lymphocyte predominant HL (NLP), lymphocyte rich (LR), mixed cellularity (MC), lymphocyte depleted (LD), and nodular sclerosis (NS). Treatment modality included RT alone, CT alone, RT and CT combined, and no RT or CT. Survival time was estimated by using the date of diagnosis and one of the following dates: date of death, date last known to be alive or date of the study cutoff (December 31, 2014). Chi-square test and multivariate Cox regression were performed by using SAS 9.4 (SAS Institute Inc., Cary, NC, USA). Exclusion criteria include: 1) patients with unknown or unspecified race; 2) patients who survived less than 6 months because time of radiotherapy/chemotherapy was not known to the time of diagnosis; 3) patients with any other type of cancer prior to the diagnosis of HL; 4) patients with second or later primaries, and who were not actively followed. Results: A total of 14.286 HL patients were included in the analysis. Table 1 indicates the insurance status and demographic and tumor characteristics among HL patients diagnosed between 2007 and 2014. Patients with black race, male sex, and B symptoms were more likely to be uninsured and on any Medicaid compared to other races, female sex and without B symptoms (p&lt;0.01). As stage of disease increased, the percentage of insured patients decreased from 82.0% to 71.7%, (p&lt;0.01). As with year of diagnosis advanced, the percentage of uninsured did not appear to be changed however the proportion of both those with insurance and any Medicaid decreased slightly by 2.4% (p&lt;0.01). Those who received RT only were most likely to have insurance (89.6%) followed by combination modality (80.1%). As expected, uninsured status was associated with lower income and education level (p&lt;0.01). Table 2 shows the insurance and hazard ratio among HL patients by year of diagnosis adjusting for race, sex, histology type, income, education, and year of diagnosis. Any Medicaid patients had the highest HR of death from 2007-2010 compared to insured patients. Without insurance was also associated with increased risk of death but only significant in 2008, HR=2.26, 95% CI (1.35, 3.80). The survival outcomes comparing different insurance status by age groups (&lt;=29 and 30-64) were demonstrated in Kaplan-Meier Curve. In the age 29 or less group, insured patient showed has the best survival outcome followed by any Medicaid and then the uninsured. In the age 30-64 group, Medicaid patients had the worst survival outcome compared to those with or without insurance. Conclusion: Insurance status is one of the most important contributors of health disparity, especially in malignancy given the significant financial toxicity of therapies. We found that the proportion of the uninsured was trending up before the Affordable Care Act (ACA). Regarding the HL outcome, insured patients had the best survival across all age groups even though not significantly while Medicaid patients had the worst outcomes in almost all age groups, even worse than the uninsured after adjusting for the disease stage at diagnosis and sociodemographic factors. It would be of interest to explore the reason behind Medicaid patients' relatively poor outcomes. Future studies may also investigate how ACA, Medicaid expansion, and the possible upcoming republican healthcare reform influence HL outcome. Disclosures No relevant conflicts of interest to declare.

Abrogation of survival disparity between insured and uninsured individuals after the USPSTF's 2012 prostate-specific antigen-based prostate cancer screening recommendation.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 77-77
Author(s):  
Isaac Elijah Kim ◽  
Daniel D. Kim ◽  
Sinae Kim ◽  
Eric A. Singer ◽  
Thomas L. Jang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Marital Status ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Insurance Status ◽  
Uninsured Patients ◽  
Housing Status ◽  
Diagnostic Time ◽  
Urban Rural ◽  
Insured Patients

77 Background: In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA)-based screening for prostate cancer. Studies have found that insured patients with prostate cancer have better outcomes than uninsured patients. We examined the recommendation’s effects on survival disparities based on insurance status as well as socioeconomic quintile, marital status, and housing (urban/rural). Methods: Using the SEER18 database, we examined prostate cancer-specific survival (PCSS) based on diagnostic time period and one of four factors: insurance status, socioeconomic quintile, marital status, and housing (urban/rural). The SEER-designated socioeconomic quintile was based on variables including median household income and education index. Patients were designated as belonging to the pre-USPSTF era if diagnosed in 2010-2012 or post-USPSTF era if diagnosed in 2014-2016. Disparities were measured with the Cox proportional hazards model. Results: We identified 282,994 patients diagnosed with prostate cancer. During the pre-USPSTF era, uninsured patients experienced worse PCSS compared to insured patients (adjusted HR 1.29, 95% CI 1.06-1.58, p = 0.01). This survival disparity narrowed during the post-USPSTF era as a result of decreased PCSS among insured patients combined with unchanged PCSS among uninsured patients. Moreover, the survival disparity was no longer observed during the post-USPSTF era (aHR 0.91, 95% CI 0.61-1.38, p = 0.67). The survival disparity based on socioeconomic quintile also narrowed but remained significant. In contrast, the survival disparity based on marital status widened, while housing status was not associated with survival disparities in either era. Conclusions: From the pre- to the post-USPSTF era, insured patients with prostate cancer observed a significant decrease in survival that made their survival outcomes similar to that of uninsured patients. Although the underlying reasons are not clear, the USPSTF’s 2012 PSA screening recommendation may have hindered insured patients from being regularly screened for prostate cancer and selectively led to worse outcomes for insured patients without improving the survival of uninsured patients.[Table: see text]

scholarly journals Association between Insurance Status and Hospital Length of Stay following Trauma

2016 ◽  
Vol 82 (3) ◽  
pp. 281-288 ◽  
Author(s):  
Brian R. Englum ◽  
Xuan Hui ◽  
Cheryl K. Zogg ◽  
Muhammad Ali Chaudhary ◽  
Cassandra Villegas ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Insurance Status ◽  
Trauma Patients ◽  
Uninsured Patients ◽  
National Trauma ◽  
Insured Patients ◽  
The Relationship

Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient's ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes.

scholarly journals Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

2012 ◽  
Vol 32 (2) ◽  
pp. 159-167 ◽  
Author(s):  
Nobuhiro Ayuzawa ◽  
Yoshitaka Ishibashi ◽  
Yutaka Takazawa ◽  
Haruki Kume ◽  
Toshiro Fujita
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Practice ◽  
University Hospital ◽  
Dialysis Therapy ◽  
Compact Zone ◽  
Peritoneal Biopsy ◽  
The Mean ◽  
The Impact ◽  
Peritoneal Morphology

♦BackgroundMorphology changes of the peritoneal membrane after long-term peritoneal dialysis (PD) consist of denudation of peritoneal mesothelial cells, interstitial sclerosis, and hyalinizing vasculopathy. Those changes are considered to be the result of uremia and bioincompatible effects of conventional acidic lactate-buffered dialysate with glucose degradation products (GDPs). In the last decade, biocompatible dialysate with neutral pH and low GDPs has become widely used. Clinical practice has been modified in Japan, especially for anuric patients, and now includes the use of hybrid therapy. The impact on peritoneal morphology has not been well reported.♦ ObjectiveThe aim of the present study was to investigate the long-term effect on peritoneal morphology and function of biocompatible fluid use and current clinical practice in Japan, including hybrid dialysis therapy.♦MethodsWe evaluated peritoneal biopsy specimens from patients who had undergone PD for more than 3 years. We used the average peritoneal thickness (APT) of the submesothelial compact zone as a marker of interstitial sclerosis and the lumen/vessel diameter ratio (L/V ratio) at postcapillary venules as a marker of hyalinizing vasculopathy. Demography and other data for the patients, including dialysate-to-plasma (D/P) ratio of creatinine, were obtained at baseline and every 6 months by peritoneal equilibration test.♦ResultsBetween 2002 and 2009, 110 patients started PD therapy with biocompatible dialysate at Tokyo University Hospital. Among them, 11 patients (8 men, 3 women; age: 54.2 ± 11.8 years; 1 with diabetes mellitus) were enrolled into this morphology study. The mean duration of PD in this group was 61 ± 11.3 months, and the mean time to peritoneal biopsy was 58 ± 15.1 months. The median APT was 180 μm (96 – 1424 μm), and the median L/V ratio was 0.66 (0.46 – 0.74). No obvious correlations between APT, L/V ratio, and PD duration were detected. The D/P creatinine of the 11 patients was maintained at a favorably low value, comparable with that of the other 99 patients.♦ConclusionsPeritoneal dialysis therapy using biocompatible dialysate in conjunction with modification of clinical practice may minimize the progression of peritoneal interstitial sclerosis and hyalinizing vasculopathy, preserving favorable peritoneal function for more than 3 years.

scholarly journals Risk of health morbidity for the uninsured: 10-year evidence from a large hospital center in Boston, Massachusetts

2018 ◽  
Vol 31 (5) ◽  
pp. 325-330 ◽  
Author(s):  
Zhaoyi Chen ◽  
Jae Min ◽  
Jiang Bian ◽  
Mo Wang ◽  
Le Zhou ◽  
...  
Keyword(s):  
Private Insurance ◽  
Insurance Coverage ◽  
Multivariable Analysis ◽  
Insurance Status ◽  
Uninsured Patients ◽  
Large Hospital ◽  
Risk Of Death ◽  
Voluntary Withdrawal ◽  
Life Threatening ◽  
Independent Association

AbstractObjectiveTo investigate the independent contribution of insurance status toward the risk of diagnosis of specific clinical comorbidities for individuals admitted to intensive care unit (ICU).DesignRetrospective analysis of secondary database.SettingTen years of public de-identified ICU electronic medical records from a large hospital in USA.ParticipantsPatients (18–65 years old) who had private insurance or no insurance were extracted from the database.Main outcome measuresIndependent association of insurance status (uninsured vs. privately insured) with the risk of diagnosis of specific clinical comorbidities.ResultsAmong 14 268 (from 11 753 patients) admissions to ICU between 2001 and 2012, 96% of them were covered by private insurance. Patients with private insurance had higher proportion of females, married, White race, longer ICU stay and more procedures during stay, and fewer deaths. A lower CCI was observed in uninsured patients. At multivariable analysis, uninsured patients had higher odds of death and of admissions for accidental falls, substance or alcohol abuse.ConclusionsPatients with no insurance coverage were at higher risk of death and of admission for physical and substance-related injury. We did not observe a higher risk for acute life-threatening diseases such as myocardial infarction or kidney failure. The lower CCI observed in the uninsured may be explained by under diagnosis or voluntary withdrawal from coverage in the pre-Affordable Care Act era. Replication of findings is warranted in other populations, among those with government-subsidized insurance and in the procedure/prescription domains.

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