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In-hospital mortality outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI) who are uninsured compared to those with Medicaid is unclear.
Using the Nationwide Inpatient Sample data files from 2003 to 2014, we identified patients 18 years of age and older who presented with a primary diagnosis of STEMI. Depending upon primary payer status, patients were categorized into two groups: Medicaid and Uninsured groups. Propensity-score matched analysis was performed using caliper matching to adjust for baseline demographic characteristics. Binary logistic regression was performed to adjust for in-hospital characteristics and identify independent predictors of in-hospital mortality.
Of 102,161 adult STEMI patients, 42,062 patients (41.2%) had Medicaid, whereas 60,099 patients (58.8%) were uninsured. Propensity-score matched analysis identified 8,315 patients with Medicaid and 8,315 patients without health insurance. Independent predictors of in-hospital mortality were acute stroke (OR=4.46, 95% CI=3.15-6.31, P=0.0005), gastrointestinal bleeding (OR=2.16, 95% CI=1.56-3.01, P=0.0005), pneumonia (OR=1.49, 95% CI=1.17-1.91, P=0.001), acute kidney injury (OR=3.31, 95% CI=2.76-3.95, P=0.0005), cardiac arrest (9.31, 95% CI=7.93-10.93, P=0.0005), and cardiogenic shock (OR=5.01, 95% CI=4.22-5.96, P=0.0005). Medicaid did not predict a better in-hospital mortality (OR=0.86, 95% CI=0.73-1.00, P=0.53). The model demonstrated excellent statistical discrimination (C-statistic=0.913).
Proving health insurance to underprivileged patients is not associated with improved outcomes in patients presenting with STEMI. Investing resources in improving health literacy and education may provide better value for the taxpayer dollar.
CORONARY: Acute Myocardial Infarction