Health Disparities Attributed to Medicare-Medicaid Dual-Eligible Status in Patients with Peripheral Arterial Disease

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J Vasc Surg. 2021 Dec 16:S0741-5214(21)02606-9. doi: 10.1016/j.jvs.2021.11.069. On the internet forward of print.


Goal: Peripheral arterial disorder (PAD) is a commonplace and debilitating disorder that can be effectively addressed by surgical revascularization. Nevertheless, Medicare-Medicaid twin-suitable sufferers expertise even worse extensive-term results, notably higher rates of amputation and mortality, relative to other insurance policy teams. This study aims to investigate how insurance standing could perpetuate wellbeing disparities in PAD outcomes.

Techniques: The National Inpatient Sample was queried from 2000 to 2011 for patients ≥18 years with PAD who underwent surgical revascularization with hospitalization. Sufferers had been stratified by insurance, and twin-eligibles were being compared to Medicare-only, Medicaid-only, private insurance policy, and self-pay sufferers. Multivariable regression investigation was executed to assess the effect of dual-eligible position on postoperative outcomes these kinds of as inpatient mortality, issues, and favorable discharge (property or residence with companies).

Results: A complete of 771,790 hospitalizations ended up included in the investigation and stratified according to insurance coverage sort. Dual-qualified clients had the greatest rates of significant (32%) and severe (11%) severity of ailment and the highest premiums of important (19%) and serious (6%) chance of mortality amid all coverage teams (p<0.001). Dual-eligibility status was independently associated with reduced odds of favorable discharge relative to all patients (p<0.001) and increased length of stay relative to Medicare-only (p=0.002) and private-payor groups (p<0.001). While dual-eligible patients had increased mortality odds relative to Medicaid-only and self-pay groups, they did not have significantly different odds of perioperative complications relative to all other insurance groups.

CONCLUSIONS: Medicare-Medicaid dual-eligible patients with PAD had more severe clinical presentations, a greater risk of extended hospitalizations, and a lower likelihood of being discharged home, relative to patients without dual-eligibility. Further studies are needed to examine the link between discharge disposition and disparities in health outcomes, as well as investigate interventions that effectively address the increased severity of PAD in dual-eligible patients.

PMID:34923069 | DOI:10.1016/j.jvs.2021.11.069