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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Effect of Insurance Status on Outcomes of Acute Ischemic Stroke Patients Receiving Intra-Arterial Treatment: Results from the Paul Coverdell National Acute Stroke Program
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Effect of Insurance Status on Outcomes of Acute Ischemic Stroke Patients Receiving Intra-Arterial Treatment: Results from the Paul Coverdell National Acute Stroke Program

机译：保险状况对接受动脉内治疗的急性缺血性卒中患者结果的影响：Paul Coverdell国家急性中风方案的结果

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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.
机译：背景：在美国，中风仍然是导致死亡和残疾的主要原因。动脉内再灌注治疗（IAT）治疗急性缺血性卒中（AIS）的比率正在增加，这些治疗与更有利的预后相关。我们试图在一个多州卒中登记系统中，研究保险状态对接受IAT治疗的AIS患者预后的影响。方法：我们使用2014年至2019年Paul Coverdell国家急性卒中计划（PCNASP）的数据来量化AIS后IAT（有或没有静脉溶栓）的发生率。我们根据保险状况对结果进行建模：私人、医疗保险、医疗补助或无保险。结果定义为出院回家率、住院死亡率、症状性颅内出血（sICH）或住院期间危及生命的出血率。结果：在研究期间，PCNASP的674家参与医院中有486180名患者临床诊断为AIS（平均年龄70.6岁，50.3%为男性）。只有4.3%的患者接受了任何IAT。与私人保险相比，接受任何IAT的未参保患者更有可能发生院内死亡（AOR 1.36[95%CI 1.07-1.73]）。医疗保险（AOR 0.78[95%CI 0.71-0.85]）和医疗补助（AOR 0.85[95%CI 0.75-0.96]）受益人出院回家的可能性较小，但未参保患者出院回家的可能性更大（AOR 1.90[95%CI 1.61-2.24]）。未发现保险状况与sICH的发病率独立相关。结论：在接受IAT的AIS患者中，保险状况与住院死亡和出院回家独立相关。

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