Outcomes Poorer for Medicaid Beneficiaries With STEMI
Rates of revascularization lower, in-hospital mortality higher for Medicaid versus privately insured
THURSDAY, Jan. 10, 2019 (HealthDay News) -- Among patients with ST-segment-elevation myocardial infarction (STEMI), Medicaid beneficiaries have lower rates of revascularization and higher in-hospital mortality than patients with private insurance, according to a study published online Jan. 4 in Circulation: Cardiovascular Quality and Outcomes.
Nirav Patel, M.D., from the University of Alabama at Birmingham, and colleagues queried the National Inpatient Sample from 2012 to 2015 for STEMI hospitalizations with the primary payer of Medicaid or private insurance. Outcomes were compared in a propensity score-matched cohort based on demographics, socioeconomic status, clinical comorbidities, STEMI acuity, and hospital characteristics. Data were included for 42,645 and 171,545 STEMI hospitalizations for patients identified as having Medicaid and private insurance, respectively.
The researchers found that compared with those privately insured, Medicaid beneficiaries with STEMI had lower rates of coronary revascularization (88.9 versus 92.3 percent; odds ratio, 0.67) and higher rates of in-hospital mortality (4.9 versus 2.8 percent; odds ratio, 1.81) in unadjusted analyses. In a propensity-matched cohort including 40,870 hospitalizations per group, the results were similar, with lower rates of revascularization (89.1 versus 91.1 percent; odds ratio, 0.80) and higher in-hospital mortality (4.9 versus 3.7 percent; odds ratio, 1.35) for those with Medicaid versus those privately insured.
"Additional studies to identify and understand the reasons behind the disparities in STEMI outcomes by insurance status are needed," the authors write.