Impact of Insurance Status and Race on Outcomes in Nonvariceal Upper Gastrointestinal Hemorrhage: A Nationwide Analysis.

ABSTRACT

BACKGROUND AND GOALS We examined the interaction between race, insurance, and important outcomes in nonvariceal upper gastrointestinal hemorrhage (NVUGIH). STUDY Adults with NVUGIH were selected from the National Inpatient Sample. PRIMARY OUTCOME: in-hospital mortality. SECONDARY OUTCOMES: treatment modalities [esophagogastroduodenoscopy (EGD), early EGD, and endoscopic or radiologic therapy], and resource utilization (length of hospital stay and total hospitalization charges). RESULTS: Mortality was similar for Medicare and private insurance [adjusted odds ratios (aOR) 1.15 95% confidence interval (CI) 0.90 to 1.47), P=0.24], but higher for under/uninsured patients [aOR 1.84 (CI 1.42 to 2.40), P<0.01]. Compared with Medicare, patients with private insurance had more EGDs [aOR 1.35 (CI 1.23 to 1.48), P<0.01], early EGDs [aOR 1.29 (CI 1.21 to 1.38), P<0.01], and endoscopic [aOR 1.19 (CI 1.11 to 1.27), P<0.01], or radiologic therapy [aOR1.35 (CI 1.06 to 1.71), P=0.01]. Patients who were under/uninsured had less EGDs [aOR 0.84 (CI 0.76 to 0.91), P<0.01] or endoscopic therapy [aOR 0.74 (CI 0.68 to 0.81), P<0.01], but similar odds of early EGD [aOR 0.95 (CI 0.88 to 1.02), P=0.13] or radiologic therapy [aOR 1.01 (CI 0.75 to 1.37), P=0.75]. Compared with whites, blacks had lower [aOR 0.73 (CI 0.58 to 0.93), P=0.01] and Native Americans higher mortality [aOR 2.60 (CI 1.57 to 4.13), P<0.01]. Blacks were less likely [aOR 0.86 (CI 0.79 to 0.94), P<0.01] and Asians more likely [aOR 1.24 (CI 1.05 to 1.47), P=0.01] to have EGDs. Both blacks and Hispanics had lower, whereas Asians had higher early EGD rates. Patients with private insurance had lower total charges [adjusted mean difference -$2761 (CI -$4617 to -$906), P<0.01]. CONCLUSIONS: Insurance and race have independent effects on NVUGIH mortality, therapeutic modalities used, and resource utilization. Black and under/uninsured patients have the worst outcomes.