Health Insurance Status Linked to Higher ICU Mortality Risk

Janice Simmons, May 18, 2010

Adult patients without health insurance admitted to intensive care units in Pennsylvania hospitals had a 21% higher risk of death compared to other patients with private insurance, according to University of Pennsylvania researchers.

The differences in mortality risk were not explained by patient characteristics or differences in the hospitals they were admitted to, suggesting that uninsured patients might be receiving poorer quality care—for a variety of reasons. The findings are being presented this week at the American Thoracic Society 2010 International Conference in New Orleans.

Compared to similar patients with private insurance or Medicaid, the uninsured ICU patients were found to less likely receive various common critical care procedures, such as placement of central venous catheters, tracheostomies, and acute hemodialysis.

"Previous studies suggested that uninsured critically ill patients may have a higher mortality, and may be less likely to receive certain critical care procedures. But we found that these differences are primarily due to differences in quality within hospitals rather than across hospitals," said Sarah Lyon, MD, a pulmonary and critical care fellow at the Hospital of the University of Pennsylvania, in a statement.

The higher mortality for uninsured patients "does not appear to be caused by uninsured patients tending to go to hospitals with poor overall quality," Lyon said. "Instead, we found that even when admitted to the same hospitals, and controlling for other differences between patients, critically ill individuals without insurance are less likely to survive than those with private or Medicaid insurance."

Thirty-day mortality rates and the use of several key ICU procedures were examined among all adult patients under age 65 admitted to Pennsylvania ICUs from 2005 to 2006. They used state hospital discharge data, and categorized the 166,995 patients as having private health insurance (67.7%), Medicaid (28.5%), or being uninsured (3.8%).

When the researchers analyzed mortality at 30 days, they found that uninsured patients were 21% more likely to die than patients with private insurance. Those with Medicaid had a 3% greater risk of death.

While their findings suggested that ICU patients without insurance have a higher risk of death, "expanding and standardizing healthcare coverage through healthcare reform may improve outcomes in critically ill patients," Lyon said.

The researchers also said that differences in survival between the insured and uninsured may be related to critically ill patients without insurance arriving at the hospital in more advanced stages of illness—"perhaps in ways we could not control for in our study." Lyon said.

Those patients without insurance also may have different preferences for intensity of care at the end of life, and may not wish to be kept alive on life support as long as patients with insurance, she said. In the long run, more work will be needed "before we can say with certainty that treatment biases caused these results."

Janice Simmons Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at
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