Socio-demographic and clinical factors associated with increased sepsis risk, including older age, non-white race and specific co-morbidities, are more common among patients with Medicare or Medicaid or no health insurance. James M O'Brien Jr., of the Department of Internal Medicine in the Center for Critical Care at Ohio State University Medical Center, and colleagues, hypothesized that patients with Medicare and/or Medicaid or without health insurance have a higher risk of sepsis-associated hospitalization or sepsis-associated death than those with private health insurance.
The researchers performed a retrospective cohort study of records from the 2003 Nationwide Inpatient Sample. They stratified the study cohort by Medicare age-qualification (18 to 64 and 65-plus years old) and examined the association between insurance category and sepsis diagnosis and death among admissions involving sepsis. They used validated diagnostic codes to determine the presence of sepsis, co-morbidities and organ dysfunction and to provide risk-adjustment.
Among patients 18 to 64 years old, those with Medicaid (adjusted odds ratio [AOR] 1.50), Medicare (AOR 1.96), Medicaid + Medicare (AOR 2.22) and the uninsured (AOR 1.18) had significantly higher risk-adjusted odds of a sepsis-associated admission than those with private insurance (all P<0.0001). Those with Medicaid (AOR 1.17, P<0.001) and those without insurance (AOR 1.45, P<0.001) also had significantly higher adjusted odds of sepsis-associated hospital mortality than those with private insurance. Among those 65-plus years old, those with Medicaid (AOR 1.43), Medicare alone (AOR 1.13) or Medicaid and Medicare (AOR 1.62) had significantly higher risk-adjusted odds of sepsis-associated admission than those with private insurance and Medicare (all P<0.0001). Among sepsis patients 65-plus, uninsured patients had significantly higher risk-adjusted odds (AOR 1.45, P=0.0048) and those with Medicare alone had significantly lower risk-adjusted odds (AOR 0.92, P=0.0072) of hospital mortality than those with private insurance and Medicare. Lack of health insurance remained associated with sepsis-associated mortality after stratification of hospitals into quartiles based on rates of sepsis-associated admissions or mortality in both age strata.
The researchers concluded that risks of sepsis-associated hospitalization and sepsis-associated death vary by insurance. They add that these increased risks were not fully explained by the available socio-demographic factors, co-morbidities or hospital rates of sepsis-related admissions or deaths. Their research was published in Critical Care.
Reference: O'Brien JM, Lu B, Ali NA, Levine DA, Aberegg SK and Lemeshow S. Insurance type and sepsis-associated hospitalizations and sepsis-associated mortality among US adults: a retrospective cohort study. Critical Care 2011, 15:R130doi:10.1186/cc10243.