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Effect of insurance status on patients admitted for acute diverticulitis
Author(s) -
Mills A. M.,
Holena D. N.,
Kallan M. J.,
Carr B. G.,
Reinke C. E.,
Kelz R. R.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12066
Subject(s) - medicine , medicaid , diverticulitis , retrospective cohort study , emergency medicine , family medicine , health care , economics , economic growth
Aim The study aimed to evaluate the relationship between insurance status and the management and outcome of acute diverticulitis in a nationally representative sample. Method A retrospective cohort analysis of a nationally representative sample of 1 031 665 hospital discharges of patients admitted for acute diverticulitis in the 2006–2009 Nationwide Inpatient Sample ( NIS ), H ealthcare C ost and U tilization P roject data set. The main outcome measures included state at presentation (complicated/uncomplicated), management (medical/surgical), time to surgical intervention, type of operation and inpatient death. Results In total, 207 838 discharges were identified (including 37.0% with private insurance, 49.3% in Medicare, 5.6% in Medicaid and 5.8% uninsured) representing 1 031 665 total discharges nationally. Medicare patients were more likely to present with complicated diverticulitis compared with private insurance patients (23.8% vs 15.1%). Time to surgical intervention differed by insurance status. After adjusting for patient, hospital and treatment factors, Medicare patients were less likely than those with private insurance to undergo a procedure (Medicare OR = 0.86, 95% CI : 0.82–0.91), while the uninsured were more likely to undergo drainage ( OR = 1.30, 95% CI : 1.16–1.46) or a colostomy only ( OR = 1.70, 95% CI : 1.24–2.33). All patients without private insurance were more likely to die in hospital (Medicare OR = 1.29, 95% CI : 1.09–1.52; Medicaid OR = 1.55, 95% CI : 1.22–1.97; uninsured OR = 1.41, 95% CI : 1.07–1.87). Conclusion In a nationally representative sample of patients with acute diverticulitis, patient management and outcome varied significantly by insurance status, despite adjustment for potential confounders. Providers might need to heighten surveillance for complications when treating patients without private insurance to improve outcome.