Insurance status, not race, is associated with mortality after an acute cardiovascular event in maryland
Journal of General Internal Medicine, 08/10/2012
Ng DK et al. – Race was not associated with an increased risk of death, before or after adjustment. Being underinsured was strongly associated with death among those admitted with myocardial infarction, or a coronary atherosclerosis event. These results support growing evidence implicating insurance status and socioeconomic factors as important drivers of health disparities, and potentially racial disparities.Methods
- Prospective cohort study in three hospitals in Maryland representing different demographics between 1993 and 2007.
- Patients with an incident admission who were either white or black, and had either private insurance, state–based insurance or were uninsured.
- 4,908 patients were diagnosed with acute myocardial infarction, 6,759 with coronary atherosclerosis, and 1,293 with stroke.
- Demographic and clinical patient–level data were collected from an administrative billing database and neighborhood household income was collected from the 2000 US Census.
- The outcome of all–cause mortality was collected from the Social Security Death Master File.
- In an analysis adjusted for race, disease severity, location, neighborhood household income among other confounders, being underinsured was associated with an increased risk of death after myocardial infarction (relative hazard, 1.31 [95 % CI: 1.09, 1.59]), coronary atherosclerosis (relative hazard, 1.50 [95 % CI: 1.26, 1.80]) or stroke (relative hazard, 1.25 [95 % CI: 0.91, 1.72]).
- Black race was not associated with an increased risk of death after myocardial infarction (relative hazard, 1.03 [95 % CI: 0.85, 1.24]), or after stroke (relative hazard, 1.18 [95 % CI: 0.86, 1.61]) and was associated with a decreased risk of death after coronary atherosclerosis (relative hazard, 0.82 [95 % CI: 0.69, 0.98]).