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Effect of Insurance Type on Adverse Cardiac Events After Percutaneous Coronary Intervention

Published:December 24, 2010DOI:https://doi.org/10.1016/j.amjcard.2010.10.041
      Previous studies have documented disparities in both access to invasive cardiovascular procedures and outcomes in patients with Medicaid, Medicare, or no insurance. Outcomes by insurance have yet not been examined in a percutaneous coronary intervention (PCI) population. Data from patients undergoing PCI from June 2000 to June 2009 were retrospectively analyzed. Insurance was categorized as private, Medicare, Medicaid, and uninsured, according to the primary insurance at discharge. The outcome variable of interest was major adverse cardiac events (a composite of death, Q-wave myocardial infarction, and target vessel revascularization) at 1 year. Multivariable Cox regression analysis was stratified according to age <65 and ≥65 years. Of the 13,573 patients who had undergone PCI, 6,653 (49.0%) had private insurance, 6,150 (45.3%) had Medicare, 486 (3.6%) had Medicaid, and 284 (2.1%) were uninsured. Of the patients <65 years old, Medicaid (hazard ratio [HR] 1.59, 95% confidence interval [CI] 1.04 to 2.43), Medicare (HR 2.18, 95% CI 1.58 to 2.99), and no insurance (HR 2.41, 95% CI 1.36 to 4.27) were associated with greater rates of adjusted major adverse cardiac events at 1 year compared with private insurance. Of the patients ≥65 years old, only Medicaid (HR 3.07, 95% CI 1.09 to 8.61) was associated with a greater rate of adjusted major adverse cardiac events at 1 year. In conclusion, patients with government-sponsored insurance and no insurance have worse cardiovascular outcomes than patients with private insurance after PCI at 1 year. This implies that the provision of health insurance alone might not have a dramatic effect on cardiovascular outcomes after PCI.
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      References

        • Wenneker M.B.
        • Weissman J.S.
        • Epstein A.M.
        The association of payer with utilization of cardiac procedures in Massachusetts.
        JAMA. 1990; 264: 1255-1260
        • Canto J.G.
        • Rogers W.J.
        • Zhang Y.
        • Roseman J.M.
        • French W.J.
        • Gore J.M.
        • Chandra N.C.
        The association between the on-site availability of cardiac procedures and the utilization of those services for acute myocardial infarction by payer group.
        Clin Cardiol. 1999; 22: 519-524
        • Hadley J.
        • Steinberg E.P.
        • Feder J.
        Comparison of uninsured and privately insured hospital patients.
        JAMA. 1991; 265: 374-379
        • Sada M.J.
        • French W.J.
        • Carlisle D.M.
        • Chandra N.C.
        • Gore J.M.
        • Rogers W.J.
        Influence of payer on use of invasive cardiac procedures and patient outcome after myocardial infarction in the United States: Participants in the National Registry of Myocardial Infarction.
        J Am Coll Cardiol. 1998; 31: 1474-1480
        • Calvin J.E.
        • Roe M.T.
        • Chen A.Y.
        • Mehta R.H.
        • Brogan Jr, G.X.
        • Delong E.R.
        • Fintel D.J.
        • Gibler W.B.
        • Ohman E.M.
        • Smith Jr, S.C.
        • Peterson E.D.
        Insurance coverage and care of patients with non–ST-segment elevation acute coronary syndromes.
        Ann Intern Med. 2006; 145: 739-748
        • Canto J.G.
        • Rogers W.J.
        • French W.J.
        • Gore J.M.
        • Chandra N.C.
        • Barron H.V.
        Payer status and the utilization of hospital resources in acute myocardial infarction: a report from the National Registry of Myocardial Infarction.
        Arch Intern Med. 2000; 160: 817-823
        • Canto J.G.
        • Rogers W.J.
        • Chandra N.C.
        • French W.J.
        • Barron H.V.
        • Frederick P.D.
        • Maynard C.
        • Every N.R.
        The association of sex and payer status on management and subsequent survival in acute myocardial infarction.
        Arch Intern Med. 2002; 162: 587-593
        • United States Census Bureau
        Median household income and median owner-occupied house value by zipcode.
        (Accessed on October 19, 2009)
        • Braveman P.A.
        • Cubbin C.
        • Egerter S.
        • Chideya S.
        • Marchi K.S.
        • Metzler M.
        • Posner S.
        Socioeconomic status in health research: one size does not fit all.
        JAMA. 2005; 294: 2879-2888
        • Gerber Y.
        • Benyamini Y.
        • Goldbourt U.
        • Drory Y.
        • Israel Study Group on First Acute Myocardial Infarction
        Neighborhood socioeconomic context and long-term survival after myocardial infarction.
        Circulation. 2010; 121 (26): 375-383
        • Alter D.A.
        • Naylor C.D.
        • Austin P.
        • Tu J.V.
        Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction.
        N Engl J Med. 1999; 341: 1359-1367
        • Gaglia Jr, M.A.
        • Torguson R.
        • Xue Z.
        • Gonzalez M.A.
        • Collins S.D.
        • Ben-Dor I.
        • Syed A.I.
        • Maluenda G.
        • Delhaye C.
        • Hanna N.
        • Wakabayashi K.
        • Kaneshige K.
        • Suddath W.O.
        • Kent K.M.
        • Satler L.F.
        • Pichard A.D.
        • Waksman R.
        Insurance type influences the use of drug-eluting stents.
        J Am Coll Cardiol Interv. 2010; 3: 773-779
        • Halm E.A.
        • Lee C.
        • Chassin M.R.
        Is volume related to outcome in health care?.
        Ann Intern Med. 2002; 137: 511-520
        • Ross J.S.
        • Bradley E.H.
        • Busch S.H.
        Use of health care services by lower-income and higher-income uninsured adults.
        JAMA. 2006; 295: 2027-2036
        • Gornick M.E.
        • Eggers P.W.
        • Reilly T.W.
        • Mentnech R.M.
        • Fitterman L.K.
        • Kucken L.E.
        • Vladeck B.C.
        Effects of race and income on mortality and use of services among Medicare beneficiaries.
        N Engl J Med. 1996; 335: 791-799
        • Soobader M.
        • LeClere F.B.
        • Hadden W.
        • Maury B.
        Using aggregate geographic data to proxy individual socioeconomic status: does size matter?.
        Am J Public Health. 2001; 91: 632-636