基于保险的 COVID-19 住院患者疗效和使用 ECMO 的差异。

IF 9.1 1区 医学 Q1 ANESTHESIOLOGY
Laurent G Glance, Karen E Joynt Maddox, Michael Mazzeffi, Ernie Shippey, Katherine L Wood, E Yoko Furuya, Patricia W Stone, Jingjing Shang, Isaac Y Wu, Igor Gosev, Stewart J Lustik, Heather L Lander, Julie A Wyrobek, Andres Laserna, Andrew W Dick
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引用次数: 0

摘要

研究背景本研究的目的是探讨COVID-19住院患者在死亡率、非家庭出院和ECMO使用方面基于保险的差异:利用美国学术医疗中心及其附属医院的国家数据库,评估了死亡率、非家庭出院和 ECMO 使用与(1)保险类型(私人保险、医疗保险、医疗保险和医疗补助双重参保、无保险)和(2)每周医院 COVID-19 负担(0-5.0%;5.1-10%,10.1-20%,20.1-30%,30.1%-)之间的风险调整关联。我们扩大了建模范围,加入了付款人状况与每周医院 COVID-19 负担之间的交互作用,以研究随着 COVID-19 负担的增加,缺乏私人保险是否与差异的增加有关:在 760,846 名 COVID-19 住院患者中,214,992 人拥有私人保险,318,624 人拥有医疗保险,96,192 人同时加入了医疗保险和医疗补助计划,107,548 人拥有医疗补助计划,23,560 人没有任何保险。总计有 76250 人死亡,211702 人非居家出院,75703 人接受了机械通气,2642 人接受了 ECMO。医疗保险患者的调整后死亡几率更高(aOR:1.28;[95% CI:1.21,1.35];PC结论:在 COVID-19 患者中,基于保险的死亡率、非家庭出院和 ECMO 使用率差异很大,但这些差异并没有随着医院 COVID-19 负担的增加而增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Insurance-based Disparities in Outcomes and Extracorporeal Membrane Oxygenation Utilization for Hospitalized COVID-19 Patients.

Background: The objective of this study was to examine insurance-based disparities in mortality, nonhome discharges, and extracorporeal membrane oxygenation utilization in patients hospitalized with COVID-19.

Methods: Using a national database of U.S. academic medical centers and their affiliated hospitals, the risk-adjusted association between mortality, nonhome discharge, and extracorporeal membrane oxygenation utilization and (1) the type of insurance coverage (private insurance, Medicare, dual enrollment in Medicare and Medicaid, and no insurance) and (2) the weekly hospital COVID-19 burden (0 to 5.0%; 5.1 to 10%, 10.1 to 20%, 20.1 to 30%, and 30.1% and greater) was evaluated. Modeling was expanded to include an interaction between payer status and the weekly hospital COVID-19 burden to examine whether the lack of private insurance was associated with increases in disparities as the COVID-19 burden increased.

Results: Among 760,846 patients hospitalized with COVID-19, 214,992 had private insurance, 318,624 had Medicare, 96,192 were dually enrolled in Medicare and Medicaid, 107,548 had Medicaid, and 23,560 had no insurance. Overall, 76,250 died, 211,702 had nonhome discharges, 75,703 were mechanically ventilated, and 2,642 underwent extracorporeal membrane oxygenation. The adjusted odds of death were higher in patients with Medicare (adjusted odds ratio, 1.28 [95% CI, 1.21 to 1.35]; P < 0.0005), dually enrolled (adjusted odds ratio, 1.39 [95% CI, 1.30 to 1.50]; P < 0.0005), Medicaid (adjusted odds ratio, 1.28 [95% CI, 1.20 to 1.36]; P < 0.0005), and no insurance (adjusted odds ratio, 1.43 [95% CI, 1.26 to 1.62]; P < 0.0005) compared to patients with private insurance. Patients with Medicare (adjusted odds ratio, 0.47; [95% CI, 0.39 to 0.58]; P < 0.0005), dually enrolled (adjusted odds ratio, 0.32 [95% CI, 0.24 to 0.43]; P < 0.0005), Medicaid (adjusted odds ratio, 0.70 [95% CI, 0.62 to 0.79]; P < 0.0005), and no insurance (adjusted odds ratio, 0.40 [95% CI, 0.29 to 0.56]; P < 0.001) were less likely to be placed on extracorporeal membrane oxygenation than patients with private insurance. Mortality, nonhome discharges, and extracorporeal membrane oxygenation utilization did not change significantly more in patients with private insurance compared to patients without private insurance as the COVID-19 burden increased.

Conclusions: 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.

Editor’s perspective:

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来源期刊
Anesthesiology
Anesthesiology 医学-麻醉学
CiteScore
10.40
自引率
5.70%
发文量
542
审稿时长
3-6 weeks
期刊介绍: With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.
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