Published Online
on January 18, 2007

A more recent version of this article appeared on March 1, 2007

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Submitted on June 15, 2006
Revised on August 18, 2006
Accepted on October 3, 2006

Disparities in Outcomes Among Patients With Stroke Associated With Insurance Status

Jay J. Shen PhD^* and Elmer L. Washington MD, MPH

From the Department of Health Care Administration and Policy (J.J.S.), School of Public Health, University of Nevada at Las Vegas, Las Vegas, Nev; and Aunt Martha’s Youth Service Center, Inc. (E.L.W.), Chicago Heights, Ill.

^* To whom correspondence should be addressed. E-mail: jie.shen{at}unlv.edu.

Background and Purpose--Despite well-documented discrepancies in many clinical conditions across insurance groups, limited research has examined insurance-related disparities for patients with stroke. This study examined the relationship between insurance status and hospital care for patients with stroke.

Methods--Discharges with intracerebral hemorrhage and acute ischemic stroke were abstracted from the 2002 National Inpatient Sample. Neurologic impairment status and mortality were examined.

Results--Compared with privately insured patients, uninsured patients had a higher level of neurologic impairment, a longer average length of hospital stay, and higher mortality risk. For patients with intracerebral hemorrhage and acute ischemic stroke, mortality risk of uninsured patients was approximately 24% and 56% higher, respectively, than that of their privately insured peers.

Conclusions--Policy should promote access to outpatient and preventive care for uninsured patients so risk factors such as hypertension can be detected and treated during early, asymptomatic stages. Further research is needed to evaluate the extent to which differences in outcomes are attributable to differences in severity level on admission.

Key words: outcome • severity of illness • stroke • uninsured

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