Objective: Peripheral arterial disease (PAD) is a prevalent and debilitating disease that can be effectively treated by surgical revascularization. However, Medicare-Medicaid dual-eligible patients have experienced worse long-term outcomes, notably higher rates of amputation and mortality, relative to other insurance groups. In the present study, we investigated how insurance status can perpetuate health disparities in PAD outcomes.
Methods: The National Inpatient Sample was queried from 2000 to 2011 for patients aged ≥18 years with PAD who had undergone surgical revascularization with hospitalization. Patients were stratified by insurance status, and dual-eligible patients were compared with Medicare-only, Medicaid-only, private insurance, and self-pay patients. Multivariable regression analysis was performed to assess the effect of dual-eligible status on postoperative outcomes such as inpatient mortality, complications, and favorable discharge (home or home with services).
Results: A total of 771,790 hospitalizations were included in the present analysis and stratified by insurance type. Dual-eligible patients had the highest rates of major (32%) and extreme (11%) severity of illness and the highest rates of major (19%) and extreme (6%) risk of mortality among all insurance groups (P < .001). Dual-eligibility status was independently associated with reduced odds of favorable discharge relative to all patients (P < .001) and increased length of stay relative to Medicare-only (P = .002) and private-payor groups (P < .001). Although dual-eligible patients had increased mortality odds relative to the 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 had more severe clinical presentations, a greater risk of extended hospitalizations, and a lower likelihood of discharge to home, relative to patients without dual eligibility. Further studies are needed to examine the link between discharge disposition and disparities in healthcare outcomes and to investigate the interventions that effectively address the increased severity of PAD in dual-eligible patients.
Keywords: Medicare-Medicaid dual eligibility; National Inpatient Sample; Peripheral arterial disease; Social determinants of health.
Published by Elsevier Inc.