The Effect of Insurance Status on Ischemic Stroke Patient Outcomes: A Retrospective Analysis
Khadija Alam1, Anum Touseef Hussain2, Mahek Kataria3, Tooba Marriam4, Faraz Arshad5, Amna Kaleem Ahmed6, Tooba Hussain7, Syeda Zil e Zehra Naqvi8, Rafia Imran7, Fatima Mansoor9, Muhammad Osama Bhatti10, Noor-us-Sabah Arif6, Fatima Kaleem Ahmed11, Abdul Qahar Khan Yasinzai12, Syed Sarmad Javaid13
1Liaquat National Hospital and Medical College, Karachi Pakistan, 2CMH Lahore Medical College, Lahore, 3Chandka Medical College SMBBMU, Larkana Pakistan, 4Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore Pakistan, 5Shaikh Zayed Hospital, Lahore, 6Jinnah Medical and Dental College, Karachi Pakistan, 7Dow University of Health Sciences, Karachi Pakistan, 8Lahai Health, USA, 9Karachi Medical and Dental College, Karachi Pakistan, 10Wah Medical College, Rawalpindi Pakistan, 11Bahria University Medical and Dental College, Karachi Pakistan, 12University of Florida Health Cancer Centre, USA, 13Department of Medicine, University of Mississipi
Objective:
This study investigated the influence of insurance status on outcomes for patients with ischemic stroke.
Background:
Literature suggests that insurance status significantly influences inpatient outcomes. Ischemic stroke is a leading cause of morbidity and mortality, yet its association with insurance outcomes remains underexplored.
Design/Methods:
An observational analysis used data from the National Inpatient Sample (NIS) database between January 1st, 2018 and December 31st, 2020. All hospitalizations with ischemic stroke as the primary diagnosis were extracted using ICD-10 codes (I63.9). Demographics, comorbidities, hospital characteristics, and outcomes were analyzed and compared. IRB approval was exempt due to the study's retrospective nature.
Results:
We analyzed 1,601,840 ischemic stroke admissions categorizing patients by insurance status: Medicare (64%), private insurance (24%), Medicaid (10%), and others (2%). Racial distribution varied, with fewer Black and Hispanic patients in the Medicare group compared to other insurance types. Multivariable logistic regression showed Medicare patients had a 23% lower risk of in-hospital mortality than those with private insurance (odds ratio: 0.77, [95% CI 0.72-0.83], p<0.001), while patients with other insurances faced a 65% higher risk (odds ratio: 1.65, [95% CI 1.43-1.91], p<0.001). Medicare and Medicaid patients also incurred higher total hospital charges than those with private insurance (p<0.001). Length of stay (LOS) was 0.097 days longer for Medicare patients (p<0.008) and 1.94 days longer for Medicaid patients, while other insurance types had a 0.34-day longer stay compared to private insurance (p<0.001).
Conclusions:
Insurance status significantly influences ischemic stroke outcomes. Despite being older Medicare patients had lower mortality rates, while Medicaid patients had the longest stays and highest hospital charges. This emphasizes the need for targeted interventions to reduce costs and improve care.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.