Effect of insurance status on postacute care among working age stroke survivors
Abstract
Objective:
Utilization of postacute care is associated with improved poststroke outcomes. However, more than 20% of American adults under age 65 are uninsured. We sought to determine whether insurance status is associated with utilization and intensity of institutional postacute care among working age stroke survivors.
Methods:
A retrospective cross-sectional study of ischemic stroke survivors under age 65 from the 2004–2006 Nationwide Inpatient Sample was conducted. Hierarchical logistic regression models controlling for patient and hospital-level factors were used. The primary outcome was utilization of any institutional postacute care (inpatient rehabilitation or skilled nursing facilities) following hospital admission for ischemic stroke. Intensity of rehabilitation was explored by comparing utilization of inpatient rehabilitation facilities and skilled nursing facilities.
Results:
Of the 33,917 working age stroke survivors, 19.3% were uninsured, 19.8% were Medicaid enrollees, and 22.8% were discharged to institutional postacute care. Compared to those privately insured, uninsured stroke survivors were less likely (adjusted odds ratio [AOR] 0.53, 95% confidence interval [CI] 0.47–0.59) while stroke survivors with Medicaid were more likely to utilize any institutional postacute care (AOR = 1.40, 95% CI 1.27–1.54). Among stroke survivors who utilized institutional postacute care, uninsured (AOR = 0.48, 95% CI 0.36–0.64) and Medicaid stroke survivors (AOR = 0.27, 95% CI 0.23–0.33) were less likely to utilize an inpatient rehabilitation facility than a skilled nursing facility compared to privately insured stroke survivors.
Conclusions:
Insurance status among working age acute stroke survivors is independently associated with utilization and intensity of institutional postacute care. This may explain differences in poststroke outcomes among uninsured and Medicaid stroke survivors compared to the privately insured.
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Copyright © 2012 by AAN Enterprises, Inc.
Publication History
Received: October 31, 2011
Accepted: January 17, 2012
Published online: May 2, 2012
Published in print: May 15, 2012
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Authors
Author Contributions
Dr. Skolarus: drafting the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, study supervision or coordination. Dr. Meurer: revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, statistical analysis. Dr. Burke: revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, statistical analysis. Dr. Prvu-Bettger: revising the manuscript for content, including medical writing for content, analysis or interpretation of data. Dr. Lisabeth: revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, study supervision or coordination.
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