title: Hospitalizations for inflammatory bowel disease: profile of the uninsured in the United States.
abstract: BACKGROUND
  Inflammatory bowel disease (IBD) patients may be at increased risk for having no health insurance. Our objectives were to assess the prevalence of hospitalized IBD patients without insurance in the US and to characterize predictive factors.
  
  
  METHODS
  We identified IBD admissions in the Nationwide Inpatient Sample (1999-2005) and a 1% sample of general medical patients. We used population estimates from the US Census Bureau to calculate hospitalization rates, and logistic regression to determine predictors of being uninsured.
  
  
  RESULTS
  Although uninsured IBD patients were less likely to be hospitalized than those privately insured (incidence rate ratio [IRR] 0.41; 95% confidence interval [CI]: 0.38-0.45), their hospitalization rate increased from 8.3/100,000 to 12.5/100,000 (P < 0.001) over 7 years, outpacing private admissions. The proportion of uninsured IBD inpatients increased from 4.6% to 6.5% (P < 0.001), and IBD patients were more likely than general medical patients to be uninsured (5.1% vs. 4.1%, P < 0.0001). Predictors of being uninsured were being 21 to 40 years (odds ratio [OR] 1.95; 95% CI: 1.64-2.31), African American (OR 1.51; 95% CI: 1.29-0.76) or Hispanic (OR 2.21; 95% CI: 1.79-2.74), or residing in the southern US (OR 1.63; 95% CI: 1.27-2.11). Being female (OR 0.65; 95% CI: 0.61-0.70), residing in higher income neighborhoods (OR 0.69; 95% CI: 0.62-0.77), and higher comorbidity were protective factors.
  
  
  CONCLUSIONS
  The rate of uninsured IBD admissions has risen disproportionately relative to the privately insured and general medical populations. We need measures to alleviate the burden of being uninsured among young and otherwise healthy adults with IBD who are most vulnerable.
authors.affiliation: Mount Sinai Hospital IBD Centre, University of Toronto, Toronto, Ontario, Canada. gnguyen@mtsinai.on.ca
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
authors.forename: Justina
authors.initials: J
authors.lastname: Sam
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Murthy
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
authors.forename: Jill M
authors.initials: JM
authors.lastname: Tinmouth
authors.forename: Thomas A
authors.initials: TA
authors.lastname: LaVeist
mesh_terms: D000328:Adult; D005260:Female; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000628:therapy; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult