Insurance status linked with post-discharge outcomes in patients with cirrhosis
Insurance status was independently associated with acute-on-chronic liver failure in patients with cirrhosisin an analysis of data from North America published in Clinical Gastroenterology and Hepatology.
“The impact of insurance and race and ethnicity on outcomes in patients with cirrhosis who are hospitalized are relevant in overall prognostication,” Jasmohan S. Bajaj, MD, from the division of gastroenterology, hepatology and nutrition at Virginia Commonwealth University, told Healio Gastroenterology.
To explore the impact of insurance status on 90-day post-discharge outcomes, researchers analyzed data from the North American Consortium for the Study of End-Stage Liver Disease database. The study includes patients with private insurance (n = 971), Medicare (n = 770) and Medicaid (n = 265), as well as Canadian patients (n =456) and uninsured patients (n = 178).
Overall, 23% of patients were admitted to the intensive care unit, 12% developed ACLF, 7% died and 5% underwent liver transplantation. Of the 2,288 patients who were discharged from the hospital, 12% underwent liver transplantation, 19% died and 42% were readmitted within 90 days.
In their analysis, researchers determined that lack of insurance was associated with ACLF (P = .02) and inversely associated with inpatient liver transplant (P = .05) and 90-day liver transplant (P = .02).
Patients without insurance also accounted for the highest percentage of alcohol- or bleeding-related admissions and the lowest proportion of outpatient cirrhosis-related medication use.
“We found in our cohort of 2,640 inpatients with cirrhosis that uninsured patients were more likely to be hospitalized with potentially preventable conditions, develop acute-on-chronic liver failure at greater rates and also not be eligible for liver transplant during admission or at 90 days,” Bajaj said. “Being insured, regardless of the type of insurance such as Medicaid, Medicare, private or Canadian was associated with better outcomes. Race or ethnicity did not affect these outcomes. Expansion of insurance coverage of all patients with cirrhosis may improve these outcomes.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.