Title

Disparities in Outcomes among Hospitalized Women with Stroke – The Health Insurance Factor

Document Type

Chapter

Abstract

Background: Disparities in outcomes for many clinical conditions across insurance status is well documented, but little is known about the disparities for women with stroke. This study examined the relationship between insurance status and hospital care for female patients with stroke. Given the fact that the number of people without health insurance coverage is increasing, the focus of the study was on the uninsured women.

Methods: This was a cross-sectional study. Female adult hospital discharges with intracerebral hemorrhage or acute ischemic stroke were abstracted from the 2002 National Inpatient Sample (NIS). Patients' health insurance was categorized as Medicaid, private insurance, and uninsured. Neurologic impairment status and in-hospital mortality across different health insurance subgroups was examined. In addition, the receipt of carotid endarterectomy, when carotid artery occlusion was the presenting diagnosis, was also examined across insurance status.

Results: Compared to privately insured patients, uninsured patients did not have a significantly higher level of neurologic impairment, but they had a higher mortality risk. For patients with intracerebral hemorrhage and acute ischemic stroke, the morality risk of uninsured patients was 32% and 82% higher, respectively, than that of their privately insured peers. Furthermore, the likelihood for uninsured patients to receive an endarterectomy was merely 61% of that of their privately insured counterparts. Finally, disparities in the level of neurologic impairment status and mortality between women covered by Medicaid and women covered by private insurance were minimal.

Conclusion: Public policy may address health insurance related disparities in outcomes through either a more radical approach of attempting to provide universal health insurance coverage or a more incremental approach of strengthening community-based programs to promote access to outpatient and preventive care for uninsured patients.

Disciplines

Epidemiology | Gender and Sexuality | Health Services Research | Inequality and Stratification

Permissions

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