Elsevier

Journal of Vascular Surgery

Volume 48, Issue 4, October 2008, Pages 905-911.e1
Journal of Vascular Surgery

Clinical research study
From the Society for Vascular Surgery
Insurance status predicts access to care and outcomes of vascular disease

Presented at the 2007 Vascular Annual meeting, Baltimore, Md, Mar 21-24, 2007.
https://doi.org/10.1016/j.jvs.2008.05.010Get rights and content
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Objective

To determine if insurance status predicts severity of vascular disease at the time of treatment or outcomes following intervention.

Methods

Hospital discharge databases from Florida and New York from 2000-2005 were analyzed for lower extremity revascularization (LER, n = 73,532), carotid revascularization (CR, n = 116,578), or abdominal aortic aneurysm repair (AAA, n = 35,593), using ICD-9 codes for diagnosis and procedure. The indications for intervention as well as the post-operative outcomes were examined assigning insurance status as the independent variable. Patients covered under a variety of commercial insurers, as well as Medicare, were compared to those who either had no insurance or were covered by Medicaid.

Results

Patients without insurance or with Medicaid were at significantly greater risk of presenting with a ruptured AAA compared to insured (non-Medicaid) patients; while insurance status did not seem to impact post-operative mortality rates for elective and ruptured AAA repair. The uninsured or Medicaid recipients presented with symptomatic carotid disease nearly twice as often as the insured, but stroke rates after CR did not differ significantly based on insurance status. Patients with Medicaid or without insurance were more likely to present with limb threatening ischemia than claudication. In contrast to AAA repair and CR, the outcomes of LER were worse in the uninsured and Medicaid beneficiaries who had higher rates of post-revascularization amputation compared to the insured (non-Medicaid) group.

Conclusion

Insurance status predicts disease severity at the time of treatment, but once treated, the outcomes are similar among insurance categories, with the exception of lower extremity revascularization. This data suggests inferior access to preventative vascular care in the Medicaid and the uninsured populations.

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Competition of interest: none.

Additional material for this article may be found online at www.jvascsurg.org.