Insurance status and hospital care for myocardial infarction, stroke, and pneumonia

BACKGROUND: Despite widely documented variations in health care outcomes by insurance status, few nationally representative studies have examined such disparities in the inpatient setting. OBJECTIVE: To determine whether there are insurance‐related differences in hospital care for 3 common medical conditions. DESIGN AND SUBJECTS: Retrospective database analysis of 154,381 adult discharges (age 18‐64 years) with a principal diagnosis of acute myocardial infarction (AMI), stroke, or pneumonia from the 2005 Nationwide Inpatient Sample (NIS). MEASUREMENTS: For each diagnosis, we compared in‐hospital mortality, length of stay (LOS), and cost per hospitalization for Medicaid and uninsured patients with the privately insured. RESULTS: Compared with the privately insured, in‐hospital mortality among AMI and stroke patients was significantly higher for the uninsured (adjusted odds ratio [OR] 1.52, 95% confidence interval [CI] [1.24‐1.85] for AMI and 1.49 [1.29‐1.72] for stroke) and among pneumonia patients was significantly higher for Medicaid recipients (1.21 [1.01‐1.45]). Excluding patients who died during hospitalization, LOS was consistently longer for Medicaid recipients for all 3 conditions (adjusted ratio 1.07, 95% CI [1.05‐1.09] for AMI, 1.17 [1.14‐1.20] for stroke, and 1.04 [1.03‐1.06] for pneumonia), although costs were significantly higher for Medicaid recipients for only 2 of the 3 conditions (adjusted ratio 1.06, 95% CI [1.04‐1.09] for stroke and 1.05 [1.04‐1.07] for pneumonia). CONCLUSIONS: In this nationally representative study of working‐age Americans hospitalized for 3 common medical conditions, significantly lower in‐hospital mortality was noted for privately insured patients compared with the uninsured or Medicaid recipients. Interventions to reduce insurance‐related gaps in inpatient quality of care should be investigated. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.