Lack of insurance as a barrier to care in sepsis: A retrospective cohort study

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Abstract

Nationally-representative data suggest an association between lack of insurance and in-hospital death from sepsis (Kumar et al., 2014). It remains to be determined whether this association is attributable to differences in baseline health, care-seeking behaviors, hospital care, or other factors.

Purpose:

To determine whether organ dysfunction present on admission for community-onset sepsis mediates the association between lack of insurance and mortality in sepsis.

Materials and methods:

Retrospective cohort study using public discharge data from the California Office of Statewide Health Planning and Development. Inpatients age 18–64 with community-onset sepsis at California hospitals in 2010 were identified by diagnosis codes.

Results:

Controlling for demographics, comorbidities, infection source, and hospital characteristics, lack of insurance was associated with an adjusted odds ratio (OR) of 1.26 (absolute risk difference 4.75%, p < 0.001) for organ dysfunction present on admission for community-onset sepsis. Lack of insurance predicted in-hospital mortality (adjusted OR 1.15, p < 0.001). Organ dysfunction present on admission was the only significant mediator, explaining 22.3% (p < 0.001) of the effect of lack of insurance.

Conclusions:

The association between lack of insurance and organ dysfunction on admission in community-onset sepsis suggests that lack of insurance may impede timely care for patients with community-onset infections.

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