Initial treatment of uninsured patients with ST-elevation myocardial infarction by facility percutaneous coronary
Sara Lin1, Andrew Shermeyer2, Sayeh Nikpay2
1Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Insights
Uninsured patients with ST-elevation myocardial infarction (STEMI) are less likely to receive initial treatment at PCI-capable facilities. This suggests potential disparities in accessing timely, high-quality STEMI care for the uninsured.
Area of Science:
- Cardiology
- Health Services Research
- Health Equity
Background:
- Timely reperfusion is critical for reducing morbidity and mortality in ST-elevation myocardial infarction (STEMI).
- Facilities with percutaneous coronary intervention (PCI) capabilities are essential for rapid reperfusion in STEMI cases.
- Understanding factors influencing initial care access is vital for improving STEMI outcomes.
Purpose of the Study:
- To investigate the association between insurance status and initial emergency department (ED) care at PCI-capable facilities for adult STEMI patients.
- To identify potential disparities in access to time-sensitive STEMI treatments based on insurance coverage.
Main Methods:
- Retrospective cross-sectional study using California's Department of Healthcare Access and Information database (2011-2019).
- Included adult patients with STEMI (International Classification of Diseases codes).
- Multivariable logistic regression analyzed the primary outcome (initial care by PCI-capable facility) with insurance status as the primary exposure, controlling for patient, facility, and temporal factors.
Main Results:
- Analysis of 135,358 eligible STEMI visits.
- Uninsured patients had significantly lower odds of initial treatment at PCI-capable facilities (adjusted odds ratio 0.62, 95% CI 0.54-0.72, p < 0.001).
- Results remained consistent across sensitivity analyses.
Conclusions:
- Uninsured patients with STEMI are less likely to receive initial care at PCI-capable facilities.
- Findings indicate potential disparities in accessing high-quality, time-sensitive STEMI treatment for uninsured individuals.
- Further research and interventions are needed to address these access gaps.
Background:
Timely reperfusion is necessary to reduce morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI). Initial care by facilities with percutaneous coronary intervention (PCI) capabilities reduces time to reperfusion. We sought to examine whether insurance status was associated with initial care at emergency departments (EDs) with PCI capabilities among adult patients with STEMI.
Methods:
We conducted a retrospective cross-sectional study using Department of Healthcare Access and Information, a nonpublic statewide database reporting ED visits and hospitalizations in California. We included adults initially arriving at EDs with STEMI by diagnostic code (International Classification of Diseases Ninth Revision or 10th Revision) from 2011 to 2019. Multivariable logistic regression modeling included initial care by PCI capable facility as the primary outcome and insurance status (none vs. any) as the primary exposure. Covariates included patient, facility, and temporal factors and we conducted multiple robustness checks.
Results:
We analyzed 135,358 eligible visits with STEMI included. In our multivariable model, the odds of uninsured patients being initially treated at a PCI-capable facility were significantly lower than those of insured patients (adjusted odds ratio 0.62, 95% CI 0.54-0.72, p < 0.001) and was unchanged in sensitivity analyses.
Conclusions:
Uninsured patients with STEMI had significantly lower odds of first receiving care at facilities with PCI capabilities. Our results suggest potential disparities in accessing high-quality and time-sensitive treatment for uninsured patients with STEMI.
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