Insurance disparity in cardiovascular mortality among non-elderly cancer survivors.

BACKGROUND: Insurance status plays a vital role in cancer diagnosis, treatments and survival. Cancer patients have higher cardiovascular disease (CVD) mortality than the general population. METHODS: The Surveillance, Epidemiology and End Results (SEER) program 2007-2016 was used to estimate the CVD mortality among cancer patients aged 18 to 64 years at the time of diagnosis of an initial malignancy with the eight most prevalent cancers. Standardized mortality ratios (SMRs) were calculated for each insurance (Non-Medicaid vs Medicaid vs Uninsured) using coded cause of death from CVD with adjustment of age, race, and gender. The Fine-Grey Model was used to estimate adjusted Hazard Ratios (HR) of each insurance in CVD mortality. RESULTS: A total of 768,055 patients were included in the final analysis. CVD death in patients with Medicaid insurance remained higher than in those with Non-Medicaid insurance (HR = 1.71; 95%CI, 1.61-1.81; p < 0.001). Older age, male gender, and black race were all associated with increased CVD mortality in the multivariable model. Compared to the general population, patients with Medicaid had the highest SMRs of CVD mortality, regardless of year of cancer diagnosis, follow-up time, cancer site, and race. Non-Medicaid insured patients had similar CVD mortality to the general population after 2 years out from their cancer diagnosis. CONCLUSION: Cancer patients with Non-Medicaid insurance have significantly lower CVD mortality than those with no insurance or Medicaid. The insurance disparity remained significant regardless of type of CVD, cancer site, year of diagnosis and follow-up time.

Outcomes and Utilization of Therapeutic Hypothermia in Post-Cardiac Arrest Patients in Teaching Versus Non-Teaching Hospitals: Retrospective Study of the Nationwide Inpatient Sample Database (2016).

Background Using therapeutic hypothermia (TH) reduces the core body temperature of survivors of cardiac arrest to minimize the neurological damage caused by severe hypoxia. The TH protocol is initiated following return of spontaneous circulation (ROSC) in non-responsive patients. Clinical trials examining this technique have shown significant improvement in neurological function among survivors of cardiac arrests. Though there is strong evidence to support TH use to improve the neurologic outcomes in shockable and nonshockable rhythms, predictors of TH utilization are not well-characterized. Our study tried to evaluate TH utilization, as well as the effect of the teaching status of hospitals, on outcomes, including mortality, length of stay, and total hospitalization charges. Method We conducted a retrospective analysis of the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) database. Patients with an admitting diagnosis of cardiac arrest, as identified by the corresponding International Classification of Disease, 10th Revision (ICD-10) code for the year 2016 were analyzed. In addition, we identified TH using the ICD-10 procedure code. A weighted descriptive analysis was performed to generate national estimates. Groups of patients admitted to teaching hospitals were compared to those admitted in non-teaching hospitals. Patients were stratified by age, sex, race, and demographic and clinical data, including the Charlson Comorbidity Index (CCI), for these two groups, and statistical analysis was done for the primary outcome, in-hospital mortality, as well as the secondary outcomes, including length of stay (LOS) and total hospitalization charges. Fisher's exact test was used to compare proportions and student's t-test for continuous variables. Statistical analysis was completed by linear regression analysis. Results A total of 13,780 patients met the inclusion criteria for cardiac arrest admission. The number of patients with cardiac arrest admitted to a teaching hospital was 9285. A total of 670 patients received TH, with 495 admissions to teaching hospitals. The population of females in the hypothermia group was 270. The mean age of patients received TH was 59.4 years. In patients who received TH, 65% were Caucasians followed by Hispanics (16%), with no significant statistical racial differences in groups (p=0.30). The majority of patients with TH in both groups (teaching vs. non-teaching admissions) had Medicare (58.8% vs 49.5%; p=0.75). Hospitals in the southern region had the most admissions in both groups (45.7% and 31.3%), with the northeast region having the least non-teaching hospital admissions (8.5%) and approximately similar teaching hospital admissions in other regions (~22%) (p=0.27). The total number of deaths in this group was 510, out of which 370 were in a teaching hospital. After adjusting for age, sex, race, income, the CCI, hospital location, and bed size, mortality was not significantly different between these two groups (p=0.797). We found increased LOS in patients admitted to teaching hospitals (p=0.021). With a p-value of 0.097, there were no differences in total hospitalization charges in both groups. Conclusion There were no significant differences in mortality or total hospitalization charge between patients admitted with cardiac arrest to a teaching hospital and received TH as compared to a non-teaching hospital although patients admitted to teaching hospitals stayed longer.

Aspirin Is Associated With Reduced Rates of Venous Thromboembolism in Older Patients With Cancer.

BACKGROUND: Older patients with cancer are at high risk of developing venous thromboembolism (VTE) and bleeding. Aspirin may decrease VTE in the general population without significant bleeding. Here, we examined whether aspirin is associated with reduced rates of VTE in older patients with cancer. METHODS AND RESULTS: Using the National Inpatient Sample 2016, we retrospectively identified a cohort of patients with cancer ≥65 years old who received aspirin and a similar cohort who did not receive aspirin (n = 31 654, each). The cohorts were matched for age, sex, race, patient demographics, insurance, hospital demographics, and 9 comorbidities (smoking, obesity, hypertension, hyperlipidemia, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, congestive heart failure, and history of deep venous thrombosis [DVT]/pulmonary embolism [PE]). Primary outcomes were discharge diagnosis of acute PE or acute DVT. Secondary outcomes were inhospital mortality, bleeding, length of hospital stay (LOS), and total hospitalization cost. The aspirin group, compared with the nonaspirin group, had a significantly lower incidence of acute PE (matched, 2.1% vs 2.6%, P < .001), acute DVT (matched, 2.3% vs 3.2%, P < .001), and inhospital mortality (matched 4.0% vs 6.5%, P < .001); shorter LOS (matched, 5.29 ± 5.01 vs 6.20 ± 6.56 days, P < .001); and lower total costs (matched, US$14 700 ± 15 031 vs US$16 363 ± 20 219, P < .001). The primary and secondary outcomes were similar before and after propensity matching. We found no increase in bleeding in the aspirin group compared to the nonaspirin group: gastrointestinal bleeding (matched, 3.8% vs 4.0%, P= .168), hematuria (matched, 3.5% vs 3.7%, P = .102), hemoptysis (matched, 0.9% vs 0.9%, P = .532), and hemorrhagic stroke (matched, 0.8% vs 0.8%, P = .443). In subgroup analyses, aspirin was associated with decreased inhospital mortality, mostly in patients with lung, colon, pancreatic, prostate, breast cancer, lymphoma, and leukemia. CONCLUSIONS: Among older patients with cancer, aspirin was associated with lower VTE incidence and overall inhospital mortality without significantly increased bleeding.

The association between anxiety disorders and in-hospital outcomes in patients with myocardial infarction.

BACKGROUND: Anxiety disorders are prevalent in patients with myocardial infarction (MI), but the effects of anxiety disorders on in-hospital outcomes within MI patients have not been well studied. HYPOTHESIS: To examine the effects of concurrent anxiety disorders on in-hospital outcomes in MI patients. METHODS: We conducted a retrospective cohort study in patients with a principal diagnosis of MI with and without anxiety disorders in the National Inpatient Sample 2016. A total of 129 305 primary hospitalizations for acute MI, 35 237 with ST-segment elevation myocardial infarction (STEMI), and 94 068 with non-ST elevation myocardial infarction (NSTEMI) were identified. Of these, 13 112 (10.1%) had anxiety (7.9% in STEMI and 11.0% in NSTEMI). We compared outcomes of anxiety and nonanxiety groups after propensity score matching for the patient and hospital demographics and relevant comorbidities. RESULTS: After propensity score matching, the anxiety group had a lower incidence of in-hospital mortality (3.0% vs 4.4%, P < .001), cardiac arrest (2.1% vs 2.8%, P < .001), cardiogenic shock (4.9% vs 5.6%, P = .007), and ventricular arrhythmia (6.7% vs 7.9%, P < .001) than the nonanxiety group. In the NSTEMI subgroup, the anxiety group had significantly lower rates of in-hospital mortality (2.3% vs 3.5%, P < .001), cardiac arrest (1.1% vs 1.5%, P = .008), and cardiogenic shock (2.8% vs 3.5%, P = .008). In the STEMI subgroup, we found no differences in in-hospital outcomes (all P > .05) between the matched groups. CONCLUSION: Although we found that anxiety was associated with better in-hospital outcomes, subgroup analysis revealed that this only applied to patients admitted for NSTEMI instead of STEMI.