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Race, Ethnicity, Health Insurance, and Mortality in Older Survivors of Critical Illness
Journal article   Open access   Peer reviewed

Race, Ethnicity, Health Insurance, and Mortality in Older Survivors of Critical Illness

Matthew R. Baldwin, Jessica L. Sell, Nina Heyden, Azka Javaid, David A. Berlin, Wendy C. Gonzalez, Peter B. Bach, Mathew S. Maurer, Gina S. Lovasi and David J. Lederer
Critical care medicine, v 45(6), pp E583-E591
01 Jun 2017
DOI: https://doi.org/10.1097/CCM.0000000000002313
PMID: 28333761
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://europepmc.org/articles/pmc5433910View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Critical Care Medicine General & Internal Medicine Life Sciences & Biomedicine Science & Technology
Objectives: To determine whether minority race or ethnicity is associated with mortality and mediated by health insurance coverage among older (>= 65 yr old) survivors of critical illness. Design: A retrospective cohort study. Setting: Two New York City academic medical centers. Patients: A total of 1,947 consecutive white (1,107), black (361), and Hispanic (479) older adults who had their first medical-ICU admission from 2006 through 2009 and survived to hospital discharge. Interventions: None. Measurements and Main Results: We obtained demographic, insurance, and clinical data from electronic health records, determined each patient's neighborhood-level socioeconomic data from 2010 U.S. Census tract data, and determined death dates using the Social Security Death Index. Subjects had a mean (SD) age of 79 years (8.6 yr) and median (interquartile range) follow-up time of 1.6 years (0.4-3.0 yr). Blacks and Hispanics had similar mortality rates compared with whites (adjusted hazard ratio, 0.92; 95% CI, 0.76-1.11 and adjusted hazard ratio, 0.92; 95% CI, 0.76-1.12, respectively). Compared to those with commercial insurance and Medicare, higher mortality rates were observed for those with Medicare only (adjusted hazard ratio, 1.43; 95% CI, 1.03-1.98) and Medicaid (adjusted hazard ratio, 1.30; 95% CI, 1.10-1.52). Medicaid recipients who were the oldest ICU survivors (> 82 yr), survivors of mechanical ventilation, and discharged to skilled-care facilities had the highest mortality rates (p-for-interaction: 0.08, 0.03, and 0.17, respectively). Conclusions: Mortality after critical illness among older adults varies by insurance coverage but not by race or ethnicity. Those with federal or state insurance coverage only had higher mortality rates than those with additional commercial insurance.

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20 citations in Web of Science
16 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Critical Care Medicine
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