Abstract
Background: Socioeconomic factors, such as insurance status, have been shown to affect outcomes following emergency injuries. Dual-eligible beneficiaries, receiving both Medicare and Medicaid, constitute a vulnerable population. There is a lack of data on the impact of dual-eligible status on hemorrhagic stroke outcomes. The aim of our study was to compare hemorrhagic stroke outcomes among dual-eligible patients compared to Medicare, Medicaid, privately insured, and no charge (free or charity) patients.Study Design: We conducted a 10-year span retrospective analysis of the National Inpatient Sample. Adult patients who were emergently hospitalized for intracranial hemorrhage were included. Multivariable logistic regression was used to adjust for confounders. Primary clinical outcomes of interest included mortality (in-hospital), complications (any), and favorable discharge (home/home with services).Results: A total of 410,621 patients met inclusion of which 6.8% were dual-eligible. Dual-eligibles had higher odds of in-hospital mortality compared to no-charge (adjusted odds ratio (aOR)=1.61, 95% CI= [1.04 – 2.49]) and increased odds of complications compared to Medicaid (aOR=1.23 [1.11 – 1.37]) and privately insured patients (aOR=1.19 [1.11 – 1.28]), both p<0.001. Dual-eligibles had lower odds of favorable discharge compared to all other groups (all p<0.001), and underwent shorter lengths of stay, an 18% decrease, compared to Medicaid patients (p<0.001). Inflation adjusted admission costs among dual-eligibles were 24% lower compared to Medicaid patients (p<0.001), amounting to a $3,684 decrease in cost.Conclusions: Dual-eligible beneficiaries experience unique health disparities from lower odds of favorable discharge to increased odds of complications and in-hospital mortality compared to other insured and uninsured groups. There is a need to uncover and address unknown sources of disparities to improve emergency treatment of hemorrhagic stroke among dual-eligibles.