The hidden cost of being uninsured: Stroke mortality after mechanical thrombectomy

The impact of insurance status on mortality and functional outcomes has yet to be examined in Mechanical Thrombectomy (MT) patients, despite research on socioeconomic status.

Herein we describe the effects of insurance status on MT outcomes while controlling for other components of socioeconomic status like race, gender, and area deprivation index (ADI).

We performed a retrospective cohort study of 395 patients undergoing MT at a single comprehensive stroke center between 2018 and 2022. Patients were grouped based on presence of insurance on admission. Univariate and multivariate analysis were conducted examining the following outcome variables: length of stay (LoS), readmission within 90 days, good functional outcomes measured as a modified Rankin score at 90 days<3, and death.

A total of 44/395 (11.1 %) patients were uninsured. Uninsured patients were significantly younger on average (59.5 ± 18.2 years compared to 67.1 ± 14.7 years (p = 0.010)) On multivariate analysis, insured status was associated with improved mortality rates (OR: 0.33; 95 % CI: 0.11-0.93; p = 0.035). On univariate analysis, insured status did not have a significant effect on favorable functional outcome (OR:1.15; 95 % CI:0.56-2.34; p = 0.70), LoS (OR:1.23; 95 % CI:0.66-2.32; p = 0.511) or readmission rate (OR:1.66; 95 % CI:0.38-7.31; p = 0.50). Discharge disposition neared significance, with 50 % of insured patients being discharged to a rehabilitation facility, while only 29.3 % of uninsured patients were discharged similarly (p = 0.06).

Lack of insurance is associated with increased mortality following MT after controlling for other socioeconomic variables and may be an important marker of outcomes in AIS patients.