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Insurance Status Predicts Access To Care And Outcomes Of Vascular Disease

Jeannine K Giacovelli^1,2, Natalia Egorova², Leila Mureebe¹, Roman Nowygrod¹, Annetine Gelijns², Alan Moskowitz², James McKinsey¹, Peter L Faries¹, Kenneth Craig Kent¹, Nicholas J Morrissey.^1
1Division of Vascular Surgery, New York Presbyterian Hospital, Columbia College of Physicians and Surgeons, Weill Medical College of Cornell University, New York, NY; ²International Center for Health Outcomes and Innovation Research. Columbia University Health Sciences, New York, NY.

OBJECTIVES: To determine if insurance status is predictive of severity of vascular disease at the time of treatment and of outcomes following intervention.

METHODS: Hospital discharge databases from Florida and New York from 2000-2004 were analyzed for lower extremity revascularization (LER, n=59,833), carotid revascularization (CR, n=97,927), and abdominal aortic aneurysm (AAA, n=29,599), repair using ICD-9 codes for diagnosis and treatment. The indications for intervention as well as the post-operative outcomes were examined assigning insurance status as the independent variable. Patients insured under health maintenance organizations (HMO), Medicare, Medicare HMO, commercial insurers, Medicaid HMO, the Department of Veterans Affairs, Blue Cross, or other federal programs (Insurance Group A) were compared to those with Medicaid or without insurance (Insurance Group B).

RESULTS: Patients without insurance or with Medicaid (Group B) are at a greater than twofold risk of presenting with ruptured AAA compared to those in insurance Group A; while the post-operative mortality rates after elective AAA repair is quite similar between the groups. Patients in Group B present with symptomatic carotid disease nearly twice as often as those in Group A, but stroke rates after CR did not differ significantly. Patients with Medicaid or without insurance are more likely to present for LER with limb threatening ischemia vs. claudication. In contrast to AAA repair and CR, the outcomes of LER were diminished in Group B patients, with a higher rate of post-operative amputations compared to Group A. (Table 1 and Table 2).

CONCLUSIONS: Insurance status is a predictor of vascular disease severity at the time of presentation, but once treatment occurs the outcomes are similar among insurance categories, with the exception of lower extremity revascularization. This data suggests inferior access to care in the Medicaid and the uninsured populations.