Association Between the COVID-19 Pandemic and Insurance-Based Disparities in Mortality After Major Surgery Among US Adults.
Association Between the COVID-19 Pandemic and Insurance-Based Disparities in Mortality After Major Surgery Among US Adults.
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DOI：
10.1001/jamanetworkopen.2022.22360
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发表时间：
2022-07-01
影响因子：
13.8
通讯作者：
Maddox, Karen E. Joynt
中科院分区：
文献类型：
--
作者：
Glance, Laurent G.;Dick, Andrew W.;Shippey, Ernie;McCormick, Patrick J.;Dutton, Richard;Stone, Patricia W.;Shang, Jingjing;Lustik, Stewart J.;Lander, Heather L.;Gosev, Igor;Maddox, Karen E. Joynt
与有商业保险的患者相比，有医疗补助保险或没有保险的患者在接受大手术后死亡率的变化更大，这是否与COVID-19大流行有关？在这项对2 950 147名接受大手术的成年人进行的横断面研究中，与COVID-19负担较低的医院相比，在COVID-19负担较高的医院中，有医疗补助保险的患者和没有保险的患者的死亡率并没有比有商业保险的患者的死亡率增加更多。这些发现表明，大流行的早期阶段与大手术后死亡率的保险差异增加无关。这项横断面研究考察了保险类型是否与美国患者大手术后的COVID-19死亡率相关。COVID-19疫情对外科护理造成重大干扰。这些干扰是否对经济上处于不利地位的个人造成了不成比例的影响，目前尚不清楚。评估与有商业保险的患者相比，有医疗补助保险或无保险的患者在COVID-19大流行和大手术后死亡率之间的关联。这项横断面研究使用了Vizient临床数据库中2018年1月1日至2020年5月31日期间在美国医院接受大手术的患者的数据。2020年3月1日至5月31日第一波COVID-19病例期间的COVID-19患者住院比例，分层为低（≤ 5. 0%）、中等（5. 1%-10. 0%）、高（10. 1%-25. 0%）和非常高（> 25. 0%）。主要结局是住院死亡率。采用logistic回归的准实验三重差异方法，评估了手术后死亡率与支付者身份之间的关联，作为COVID-19住院患者比例的函数。在2 950 147例接受住院手术的成人中，（1550752名女性[52.6%]）在677家医院，主要支付者是医疗保险（1 427 791人[48.4%]），其次是商业保险（1 000 068人[33.9%]），医疗补助（321 600人[10.9%]），其他支付者（140 959人[4.8%]）和无保险（59 729人[2.0%]）。在第一波大流行期间，在COVID-19负担沉重的医院接受手术的患者死亡率增加更多（调整后的比值比[AOR]，1.13; 95% CI，1.03-1.24; P = .01）和非常高的COVID-19负担（AOR，1.38; 95%CI，1.24-1.53; P < .001）与COVID-19负担较低的医院患者相比。总的来说，与有商业保险的患者相比，有医疗补助的患者死亡几率高29%（AOR，1.29; 95%CI，1.22-1.36; P < .001），没有保险的患者死亡几率高75%（AOR，1.75; 95%CI，1.55-1.98; P < .001）。然而，有医疗补助保险的手术患者的死亡率（AOR，1.03; 95% CI，0.82-1.30; P = 0.79）或无保险（AOR，0.85; 95% CI，0.47-1.54; P = 0.60）与COVID-19负担较低的医院相比，在COVID-19负担较高的医院，19负担。这些发现在COVID-19负担非常高的医院中也是相似的。在这项横断面研究中，第一波COVID-19大流行与25. 0%以上COVID-19患者的医院手术后死亡风险较高相关。然而，与有商业保险的患者相比，在COVID-19负担非常高的医院中，大流行与无保险或有医疗补助的患者的死亡率增加无关。
Was the COVID-19 pandemic associated with greater changes in mortality after major surgery among patients with Medicaid insurance or without insurance compared with patients with commercial insurance? In this cross-sectional study of 2 950 147 adults undergoing major surgery, mortality rates among patients with Medicaid insurance and patients without insurance did not increase more than the rate among patients with commercial insurance in hospitals with a high COVID-19 burden compared with hospitals with a low COVID-19 burden. These findings suggest that the early phase of the pandemic was not associated with increases in insurance-based disparities in mortality after major surgery. This cross-sectional study examines whether insurance type was associated with COVID-19 mortality after major surgery among US patients. The COVID-19 pandemic caused significant disruptions in surgical care. Whether these disruptions disproportionately impacted economically disadvantaged individuals is unknown. To evaluate the association between the COVID-19 pandemic and mortality after major surgery among patients with Medicaid insurance or without insurance compared with patients with commercial insurance. This cross-sectional study used data from the Vizient Clinical Database for patients who underwent major surgery at hospitals in the US between January 1, 2018, and May 31, 2020. The hospital proportion of patients with COVID-19 during the first wave of COVID-19 cases between March 1 and May 31, 2020, stratified as low (≤5.0%), medium (5.1%-10.0%), high (10.1%-25.0%), and very high (>25.0%). The main outcome was inpatient mortality. The association between mortality after surgery and payer status as a function of the proportion of hospitalized patients with COVID-19 was evaluated with a quasi-experimental triple-difference approach using logistic regression. Among 2 950 147 adults undergoing inpatient surgery (1 550 752 female [52.6%]) at 677 hospitals, the primary payer was Medicare (1 427 791 [48.4%]), followed by commercial insurance (1 000 068 [33.9%]), Medicaid (321 600 [10.9%]), other payer (140 959 [4.8%]), and no insurance (59 729 [2.0%]). Mortality rates increased more for patients undergoing surgery during the first wave of the pandemic in hospitals with a high COVID-19 burden (adjusted odds ratio [AOR], 1.13; 95% CI, 1.03-1.24; P = .01) and a very high COVID-19 burden (AOR, 1.38; 95% CI, 1.24-1.53; P < .001) compared with patients in hospitals with a low COVID-19 burden. Overall, patients with Medicaid had 29% higher odds of death (AOR, 1.29; 95% CI, 1.22-1.36; P < .001) and patients without insurance had 75% higher odds of death (AOR, 1.75; 95% CI, 1.55-1.98; P < .001) compared with patients with commercial insurance. However, mortality rates for surgical patients with Medicaid insurance (AOR, 1.03; 95% CI, 0.82-1.30; P = .79) or without insurance (AOR, 0.85; 95% CI, 0.47-1.54; P = .60) did not increase more than for patients with commercial insurance in hospitals with a high COVID-19 burden compared with hospitals with a low COVID-19 burden. These findings were similar in hospitals with very high COVID-19 burdens. In this cross-sectional study, the first wave of the COVID-19 pandemic was associated with a higher risk of mortality after surgery in hospitals with more than 25.0% of patients with COVID-19. However, the pandemic was not associated with greater increases in mortality among patients with no insurance or patients with Medicaid compared with patients with commercial insurance in hospitals with a very high COVID-19 burden.
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主要付款人状况影响重大外科手术的死亡率。
影响因子：
9
作者：
LaPar DJ;Bhamidipati CM;Mery CM;Stukenborg GJ;Jones DR;Schirmer BD;Kron IL;Ailawadi G
通讯作者：
Ailawadi G
影响因子：
--
作者：
Rosen, Heather;Saleh, Fady;Gawande, Atul A.
通讯作者：
Gawande, Atul A.
影响因子：
158.5
作者：
Baker, DW;Sudano, JJ;Dor, A
通讯作者：
Dor, A
影响因子：
13.8
作者：
Mattingly AS;Rose L;Eddington HS;Trickey AW;Cullen MR;Morris AM;Wren SM
通讯作者：
Wren SM
DOI：
10.1016/j.jss.2021.05.028
发表时间：
2021-11
期刊：
The Journal of surgical research
影响因子：
--
作者：
Prasad NK;Englum BR;Turner DJ;Lake R;Siddiqui T;Mayorga-Carlin M;Sorkin JD;Lal BK
通讯作者：
Lal BK