Insurance status is associated with treatment allocation and outcomes after subarachnoid hemorrhage.
Insurance status is associated with treatment allocation and outcomes after subarachnoid hemorrhage.
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DOI：
10.1371/journal.pone.0105124
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Bihorac A
中科院分区：
文献类型：
--
作者：
Hobson C;Dortch J;Ozrazgat Baslanti T;Layon DR;Roche A;Rioux A;Harman JS;Fahy B;Bihorac A
蛛网膜下腔出血（SAH）是一种特别具有破坏性的中风类型，在65岁之前所有与中风相关的潜在寿命损失中占三分之一。手术治疗可以降低蛛网膜下腔出血后的发病率和死亡率。我们假设，支付者身份而不是私人保险与SAH患者手术治疗的分配较低和预后较差相关。我们研究了保险类型与SAH患者的手术治疗分配和结局之间的关系，同时调整了广泛的患者和医院因素。我们使用调查程序分析了全国住院患者样本出院数据库，以产生代表美国人口的加权估计值。我们研究了21047例出院病例，代表了2003年至2008年期间102595例年龄在18岁及以上且出院诊断为SAH的患者的加权估计。多变量逻辑回归和广义线性回归分析用于评估保险状况与手术分配和结果之间的任何关联。尽管手术的好处，66%的SAH患者没有接受手术治疗，以防止再出血。与接受手术治疗的患者相比，未接受手术治疗的患者的死亡率可能高出两倍以上。医疗保险患者接受手术治疗的可能性显着降低。近三分之二的SAH患者没有接受手术治疗，医疗保险患者接受手术治疗的可能性明显低于其他患者。对老年人、慢性病患者和残疾人的偏见可能在这些发现中发挥了作用。对SAH患者进行区域化护理的系统可能会减少差异，并改善手术护理的适当分配，值得进行前瞻性研究。
Subarachnoid hemorrhage (SAH) is a particularly devastating type of stroke which is responsible for one third of all stroke-related years of potential life lost before age 65. Surgical treatment has been shown to decrease both morbidity and mortality after subarachnoid hemorrhage. We hypothesized that payer status other than private insurance is associated with lower allocation to surgical treatment for patients with SAH and worse outcomes. We examined the association between insurance type and surgical treatment allocation and outcomes for patients with SAH while adjusting for a wide range of patient and hospital factors. We analyzed the Nationwide Inpatient Sample hospital discharge database using survey procedures to produce weighted estimates representative of the United States population. We studied 21047 discharges, representing a weighted estimate of 102595 patients age 18 and above with a discharge diagnosis of SAH between 2003 and 2008. Multivariable logistic and generalized linear regression analyses were used to assess for any associations between insurance status and surgery allocation and outcomes. Despite the benefits of surgery 66% of SAH patients did not undergo surgical treatment to prevent rebleeding. Mortality was more than twice as likely for patients with no surgical treatment compared to those who received surgery. Medicare patients were significantly less likely to receive surgical treatment. Nearly two thirds of patients with SAH don't receive operative care, and Medicare patients were significantly less likely to receive surgical treatment than other patients. Bias against the elderly and those with chronic illness and disability may play a part in these findings. A system of regionalized care for patients presenting with SAH may reduce disparities and improve appropriate allocation to surgical care and deserves prospective study.
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影响因子：
4.1
作者：
Andaluz, Norberto;Zuccarello, Mario
通讯作者：
Zuccarello, Mario
影响因子：
3
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影响因子：
3.5
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