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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Article info
Publication history
Published online: December 24, 2010
Accepted:
October 19,
2010
Received:
September 9,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
