title: Insurance status predicts access to care and outcomes of vascular disease.
abstract: OBJECTIVE
  To determine if insurance status predicts severity of vascular disease at the time of treatment or outcomes following intervention.
  
  
  METHODS
  Hospital discharge databases from Florida and New York from 2000-2005 were analyzed for lower extremity revascularization (LER, n = 73,532), carotid revascularization (CR, n = 116,578), or abdominal aortic aneurysm repair (AAA, n = 35,593), using ICD-9 codes for diagnosis and procedure. The indications for intervention as well as the post-operative outcomes were examined assigning insurance status as the independent variable. Patients covered under a variety of commercial insurers, as well as Medicare, were compared to those who either had no insurance or were covered by Medicaid.
  
  
  RESULTS
  Patients without insurance or with Medicaid were at significantly greater risk of presenting with a ruptured AAA compared to insured (non-Medicaid) patients; while insurance status did not seem to impact post-operative mortality rates for elective and ruptured AAA repair. The uninsured or Medicaid recipients presented with symptomatic carotid disease nearly twice as often as the insured, but stroke rates after CR did not differ significantly based on insurance status. Patients with Medicaid or without insurance were more likely to present with limb threatening ischemia than claudication. In contrast to AAA repair and CR, the outcomes of LER were worse in the uninsured and Medicaid beneficiaries who had higher rates of post-revascularization amputation compared to the insured (non-Medicaid) group.
  
  
  CONCLUSIONS
  Insurance status predicts disease severity at the time of treatment, but once treated, the outcomes are similar among insurance categories, with the exception of lower extremity revascularization. This data suggests inferior access to preventative vascular care in the Medicaid and the uninsured populations.
authors.affiliation: Division of Vascular Surgery, New York Presbyterian Hospital, Columbia College of Physicians and Surgeons, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Jeannine K
authors.initials: JK
authors.lastname: Giacovelli
authors.forename: Natalia
authors.initials: N
authors.lastname: Egorova
authors.forename: Roman
authors.initials: R
authors.lastname: Nowygrod
authors.forename: Annetine
authors.initials: A
authors.lastname: Gelijns
authors.forename: K Craig
authors.initials: KC
authors.lastname: Kent
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Morrissey
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data