Insurance-based Disparities in Outcomes and Extracorporeal Membrane Oxygenation Utilization for Hospitalized COVID-19 Patients
Authors' conclusion
Among patients with COVID-19, insurance-based disparities in mortality, nonhome discharges, and extracorporeal membrane oxygenation utilization were substantial, but these disparities did not increase as the hospital COVID-19 burden increased.
Study context
- Population
- Patients hospitalized with COVID-19 at US academic medical centers and affiliated hospitals
- Participants
- 214,992 / 318,624 / 96,192 / 107,548 / 23,560
- Exposure
- Medicare, dual enrollment, Medicaid, no insurance vs private insurance
- Private insurancen = 214,992reference
- Medicaren = 318,624
- Dually enrolledn = 96,192
- Medicaidn = 107,548
- No insurancen = 23,560
- Outcome
- Mortality, nonhome discharge and ECMO utilization by insurance type
Methodological detailsrisk-adjusted, national database of US academic medical centers
- Risk-adjusted
- National database of US academic medical centers
Main finding
As reported in the abstract
Mortality
Each group vs private insuranceAdjusted odds ratio (95% CI)P value
Medicare
1.28(1.21–1.35)
P < 0.0005Dually enrolled
1.39(1.30–1.50)
P < 0.0005Medicaid
1.28(1.20–1.36)
P < 0.0005No insurance
1.43(1.26–1.62)
P < 0.0005- Overall deaths
- 76,250
Observational data: associations, not effects.
Further findings
| Outcome | aOR (95% CI) | P value | |
|---|---|---|---|
| ECMO utilizationMedicare vs Private insurance | 0.47 (0.39–0.58) | P < 0.0005 | |
| ECMO utilizationDually enrolled vs Private insurance | 0.32 (0.24–0.43) | P < 0.0005 | |
| ECMO utilizationMedicaid vs Private insurance | 0.70 (0.62–0.79) | P < 0.0005 | |
| ECMO utilizationNo insurance vs Private insurance | 0.40 (0.29–0.56) | P < 0.001 | |
| 0.20.5125Adjusted odds ratio (log scale) |
- ECMO utilization — Overall ECMO
- 2,642
Nonhome discharge and mechanical ventilation (overall)
- Nonhome discharges
- 211,702
- Mechanically ventilated
- 75,703
Interaction of payer status with weekly hospital COVID-19 burden
- Mortality, nonhome discharges and ECMO utilization did not change significantly more in private insurance vs no private insurance as COVID-19 burden increased
- Interaction analysis
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Insurance-based Disparities in Outcomes and Extracorporeal Membrane Oxygenation Utilization for Hospitalized COVID-19 Patients. Anesthesiology. Published 25 March 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →