Analysis of 23 million US hospitalizations: uninsured children have higher all-cause in-hospital mortality
Open Access
- 29 October 2009
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Public Health
- Vol. 32 (2), 236-244
- https://doi.org/10.1093/pubmed/fdp099
Abstract
The number of uninsured children in the USA is increasing while the impact on children's health of being uninsured remains largely uncharacterized. We analyzed data from more than 23 million US children to evaluate the effect of insurance status on the outcome of US pediatric hospitalization. In our analysis of two well-known large inpatient databases, we classified patients less than 18 years old as uninsured (self-pay) or insured (including Medicaid or private insurance). We adjusted for gender, race, age, geographic region, hospital type, admission source using regression models. In-hospital death was the primary outcome and secondary outcomes were hospital length of stay and total hospital charges adjusted to 2007 dollars. The crude in-hospital mortality was 0.75% for uninsured versus 0.47% for insured children, with adjusted mortality rates of 0.74 and 0.46%, respectively. On multivariate analysis, uninsured compared with insured patients had an increased mortality risk (odds ratio: 1.60, 95% CI: 1.45–1.76). The excess mortality in uninsured children in the US was 37.8%, or 16 787, of the 38 649 deaths over the 18 period of the study. Children who were hospitalized without insurance have significantly increased all-cause in-hospital mortality as compared with children who present with insurance.This publication has 27 references indexed in Scilit:
- Differences associated with age, transfer status, and insurance coverage in end‐of‐life hospital care for childrenJournal of Hospital Medicine, 2008
- Can Massachusetts Lead the Way in Health Care Reform?New England Journal of Medicine, 2006
- Children in the United States with Discontinuous Health Insurance CoverageNew England Journal of Medicine, 2005
- Changes in Access, Utilization, and Quality of Care After Enrollment Into a State Child Health Insurance PlanPediatrics, 2005
- Use of Emergency Medical Services in Acute Myocardial Infarction and Subsequent Quality of CareCirculation, 2002
- Trends In Avoidable Hospitalizations, 1980–1998Health Affairs, 2001
- Effects of health insurance and race on colorectal cancer treatments and outcomesAmerican Journal of Public Health, 2000
- Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups.American Journal of Public Health, 1997
- Presentation adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing perspectivesJournal of Clinical Epidemiology, 1993
- The Relation between Health Insurance Coverage and Clinical Outcomes among Women with Breast CancerNew England Journal of Medicine, 1993