Sienna Wu1, Rodrigo Hasbun1, Ralph Habis2, Ivany Patel1, Jordan Benderoth2, Arun Venkatesan3, John Probasco3, Laya Rao1, Rajesh Gupta1
1UTHealth Houston, 2Johns Hopkins School of Medicine, 3Johns Hopkins Hospital
Objective:
To identify differences in health characteristics and clinical outcomes among encephalitis patients of different insurance plans and income levels.
Background:
Encephalitis is an inflammation of the brain caused largely by infectious or autoimmune etiologies. To date, the role of socioeconomic factors in the clinical characteristics and outcomes of patients with encephalitis has not been studied.
Design/Methods:
We conducted a retrospective cohort study using electronic health records from Greater Houston and Baltimore areas between 2005-2022. Insurance status was defined as public, private, both, or none. Median household income was determined by the U.S. Census Bureau using patients’ zip codes.
Results:
Of 647 patients, 569 (87.9%) had documented health insurance, with 188 (33%) on public plans, 259 (45.5%) on private, 59 (10.4%) on both, and 63 (11.1%) uninsured. Patients with both private and public insurance (dual coverage) were significantly more likely to be >60 years old and have a Charlson Comorbidity Index>2 (p<.001). Ethnic minority patients were more likely to be uninsured or on public insurance (p<.001). A greater percentage of patients with no insurance or with public insurance were immunocompromised and HIV-positive compared to those with private or dual coverage (p=.005, immune-status; p<.001, HIV-status). Lack of insurance and public insurance were associated with infectious etiology (p=.012), while dual coverage was associated with autoimmune etiology (p=.002). Lower median household income was significantly associated with being an ethnic minority, immunocompromised, HIV-positive, and an infectious etiology. There were no significant differences between insurance groups nor income levels for ICU admission, mortality, and Glasgow Outcome Score<4.
Conclusions:
Insurance status and income level impact underlying health conditions, but these disparities do not appear to translate into significant differences for patients with encephalitis once in the acute care setting. Our study demonstrates that patients receive similar, if not equitable care during hospitalization, mitigating the effects of socioeconomic status on clinical outcomes.
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