Effect of Insurance Status on Outcomes of Acute Ischemic Stroke Patients Receiving Intra-Arterial Treatment: Results from the Paul Coverdell National Acute Stroke Program

Ganesh Asaithambi, Xin Tong, Kamakshi Lakshminarayan, Sallyann M. Coleman King, Mary G. George

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Stroke continues to be a leading cause of death and disability in the United States. Rates of intra-arterial reperfusion treatments (IAT) for acute ischemic stroke (AIS) are increasing, and these treatments are associated with more favorable outcomes. We sought to examine the effect of insurance status on outcomes for AIS patients receiving IAT within a multistate stroke registry. Methods: We used data from the Paul Coverdell National Acute Stroke Program (PCNASP) from 2014 to 2019 to quantify rates of IAT (with or without intravenous thrombolysis) after AIS. We modeled outcomes based on insurance status: private, Medicare, Medicaid, or no insurance. Outcomes were defined as rates of discharge to home, in-hospital death, symptomatic intracranial hemorrhage (sICH), or life-threatening hemorrhage during hospitalization. Results: During the study period, there were 486,180 patients with a clinical diagnosis of AIS (mean age 70.6 years, 50.3% male) from 674 participating hospitals in PCNASP. Only 4.3% of patients received any IAT. As compared to private insurance, uninsured patients receiving any IAT were more likely to experience in-hospital death (AOR 1.36 [95% CI 1.07–1.73]). Medicare (AOR 0.78 [95% CI 0.71–0.85]) and Medicaid (AOR 0.85 [95% CI 0.75–0.96]) beneficiaries were less likely but uninsured patients were more likely (AOR 1.90 [95% CI 1.61–2.24]) to be discharged home. Insurance status was not found to be independently associated with rates of sICH. Conclusions: Insurance status was independently associated with in-hospital death and discharge to home among AIS patients undergoing IAT.

Original languageEnglish (US)
Article number105692
JournalJournal of Stroke and Cerebrovascular Diseases
Volume30
Issue number5
DOIs
StatePublished - May 2021

Bibliographical note

Funding Information:
The data that support findings within this study are available upon reasonable request by a qualified investigator from the corresponding author. We included patients with available insurance information admitted with a clinical diagnosis of AIS from 2014 through 2019 within the Paul Coverdell National Acute Stroke Program (PCNASP), which is funded by the Centers for Disease Control and Prevention (CDC). The PCNASP is an ongoing acute stroke quality improvement program and provides feedback to states on adherence to care guidelines in order to improve quality of care for patients hospitalized with stroke and transient ischemic attack (TIA). During our study period, there were 12 participating states (Arkansas, California, Georgia, Iowa, Massachusetts, Michigan, Minnesota, New York, North Carolina, Ohio, Washington, and Wisconsin). Hospital participation within each state is voluntary. Trained abstractors collect detailed information on stroke and TIA admissions concurrent with or soon after hospital discharge using standard data definitions provided by the CDC. 10 , 11 The PCNASP is approved by the CDC Institutional Review Board.

Publisher Copyright:
© 2021 Elsevier Inc.

Keywords

  • Insurance status
  • Intra-arterial treatment
  • Ischemic stroke
  • Outcomes

PubMed: MeSH publication types

  • Comparative Study
  • Journal Article
  • Multicenter Study

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