TY - JOUR
T1 - Insurance status as a mediator of clinical presentation, type of intervention, and short-term outcomes for patients with metastatic spine disease
AU - Price, Meghan J.
AU - De la Garza Ramos, Rafael
AU - Dalton, Tara
AU - McCray, Edwin
AU - Pennington, Zach
AU - Erickson, Melissa
AU - Walsh, Kyle M.
AU - Yassari, Reza
AU - Sciubba, Daniel M.
AU - Goodwin, Andrea N.
AU - Goodwin, C. Rory
N1 - Funding Information:
The authors have no disclosures relevant to the current work, nor any true/perceived conflicts of interest. Disclosures unrelated to the current work include: Meghan Price, BS Received funding support from the Neurosurgery Research & Education Foundation (NREF) summer medical student fellowship. Rafael De La Garza Ramos MD, Tara Dalton, MSc, Edwin McCray BS Reza Yassari, Andrea N. Goodwin, MA, MS None. Daniel M Sciubba – consulting for Depuy-Synthes, Stryker, Baxter, Augmedics. C. Rory Goodwin, MD, PhD : Received grants from the Robert Wood Johnson Harold Amos Medical Faculty Development Program , the Federal Food and Drug Administration , and the NIH/NINDS K12 NRCDP Physician Scientist Award . Consultant for Johnson & Johnson and Medtronic.
Funding Information:
The authors have no disclosures relevant to the current work, nor any true/perceived conflicts of interest. Disclosures unrelated to the current work include: Meghan Price, BS Received funding support from the Neurosurgery Research & Education Foundation (NREF) summer medical student fellowship. Rafael De La Garza Ramos MD, Tara Dalton, MSc, Edwin McCray BS Reza Yassari, Andrea N. Goodwin, MA, MS None. Daniel M Sciubba – consulting for Depuy-Synthes, Stryker, Baxter, Augmedics. C. Rory Goodwin, MD, PhD: Received grants from the Robert Wood Johnson Harold Amos Medical Faculty Development Program, the Federal Food and Drug Administration, and the NIH/NINDS K12 NRCDP Physician Scientist Award. Consultant for Johnson & Johnson and Medtronic.
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/2
Y1 - 2022/2
N2 - Background: It is well established that insurance status is a mediator of disease management, treatment course, and clinical outcomes in cancer patients. Our study assessed differences in clinical presentation, treatment course, mortality rates, and in-hospital complications for patients admitted to the hospital with late-stage cancer – specifically, metastatic spine disease (MSD), by insurance status. Methods: The United States National Inpatient Sample (NIS) database (2012–2014) was queried to identify patients with visceral metastases, metastatic spinal cord compression (MSCC) or pathological fracture of the spine in the setting of cancer. Clinical presentation, type of intervention, mortality rates, and in-hospital complications were compared amongst patients by insurance coverage (Medicare, Medicaid, commercial or unknown). Multivariable logistical regression and age sensitivity analyses were performed. Results: A total of 48,560 MSD patients were identified. Patients with Medicaid coverage presented with significantly higher rates of MSCC (p < 0.001), paralysis (0.008), and visceral metastases (p < 0.001). Patients with commercial insurance were more likely to receive surgical intervention (OR 1.43; p < 0.001). Patients with Medicaid < 65 had higher rates of prolonged length of stay (PLOS) (OR 1.26; 95% CI, 1.01–1.55; p = 0.040) while both Medicare and Medicaid patients < 65 were more likely to have non-routine discharges. In-hospital mortality rates were significantly higher for patients with Medicaid (OR 2.66; 95% CI 1.20–5.89; p = 0.016) and commercial insurance (OR 1.58; 95% CI 1.09–2.27;p = 0.013) older than 65. Conclusion: Given the differing severity in MSD presentation, mortality rates, and rates of PLOS by insurance status, our results identify disparities based on insurance coverage.
AB - Background: It is well established that insurance status is a mediator of disease management, treatment course, and clinical outcomes in cancer patients. Our study assessed differences in clinical presentation, treatment course, mortality rates, and in-hospital complications for patients admitted to the hospital with late-stage cancer – specifically, metastatic spine disease (MSD), by insurance status. Methods: The United States National Inpatient Sample (NIS) database (2012–2014) was queried to identify patients with visceral metastases, metastatic spinal cord compression (MSCC) or pathological fracture of the spine in the setting of cancer. Clinical presentation, type of intervention, mortality rates, and in-hospital complications were compared amongst patients by insurance coverage (Medicare, Medicaid, commercial or unknown). Multivariable logistical regression and age sensitivity analyses were performed. Results: A total of 48,560 MSD patients were identified. Patients with Medicaid coverage presented with significantly higher rates of MSCC (p < 0.001), paralysis (0.008), and visceral metastases (p < 0.001). Patients with commercial insurance were more likely to receive surgical intervention (OR 1.43; p < 0.001). Patients with Medicaid < 65 had higher rates of prolonged length of stay (PLOS) (OR 1.26; 95% CI, 1.01–1.55; p = 0.040) while both Medicare and Medicaid patients < 65 were more likely to have non-routine discharges. In-hospital mortality rates were significantly higher for patients with Medicaid (OR 2.66; 95% CI 1.20–5.89; p = 0.016) and commercial insurance (OR 1.58; 95% CI 1.09–2.27;p = 0.013) older than 65. Conclusion: Given the differing severity in MSD presentation, mortality rates, and rates of PLOS by insurance status, our results identify disparities based on insurance coverage.
KW - Cancer
KW - Clinical presentation
KW - In-hospital complications
KW - Insurance status
KW - Medicaid
KW - Metastatic spine disease
KW - Mortality rate
KW - Paralysis
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U2 - 10.1016/j.canep.2021.102073
DO - 10.1016/j.canep.2021.102073
M3 - Article
C2 - 34857485
AN - SCOPUS:85122929774
SN - 1877-7821
VL - 76
JO - Cancer Epidemiology
JF - Cancer Epidemiology
M1 - 102073
ER -