Outcomes for Patients with Sepsis Following Admission to the Intensive Care Unit Based on Health Insurance Status: A Study from the Medical Information Mart for Intensive Care-III (MIMIC-III) Database
Ying Zhou, Di Yang, Qiang Fu, Tao Chen, Yong Chen, Chuandong Zheng
Department of Anesthesia, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China (mainland)
Med Sci Monit 2020; 26:e924954
Available online: 2020-07-23
Previous research has focused on poor outcomes from a lack of insurance, but the effects of different types of insurance for patients with sepsis in the intensive care unit (ICU) have not been well studied. We aimed to investigate whether private health insurance was better than government-run health insurance in the United States in terms of clinical outcomes of patients with sepsis in the ICU.
MATERIAL AND METHODS: Patients with sepsis were identified from the Medical information Mart for Intensive Care-III database. Patients were grouped as having private and government-run health insurance. Clinical outcomes were compared in univariate and multivariate analyses. Propensity score match (PSM) and subgroup analysis were used to check the robustness of results.
RESULTS: Data from 13,957 patients were extracted. After adjustment by multivariate model, the private insurance group had similar rates of ICU mortality (relative risk [RR] [95% confidence interval CI]=1.052 [0.919-1.205], P=.463) and 90-day (RR [95% CI]=.964 [0.885-1.051], P=.406) compared with the group with government-run insurance. The private insurance group had longer ICU stays (strictly standardized mean difference=0.092, P<.001) and better long-term survival (hazard ratio [95% CI]=0.875 [0.825-0.928], P<.001) than the government-run insurance group in the PSM cohorts. Subgroup analysis indicated little variation in results for specific conditions.
CONCLUSIONS: Patients with sepsis who had private insurance had longer ICU stays but similar ICU mortality and 90-day mortality rates than similar patients with government-run insurance; they seemed to have better long-term survival, but more evidence may be required to support this conclusion.
Keywords: database, Hospital Mortality, Insurance, Major Medical, propensity score, Sepsis, Survival Rate