title: Insurance type influences the use of drug-eluting stents.
abstract: OBJECTIVE
  We sought to examine the effect of insurance type upon the likelihood of receiving a drug-eluting stent (DES).
  
  
  BACKGROUND
  Recent guidelines suggest that consideration of a patient's resources should play a role in decisions to use DES. Previous studies have also documented disparities in both access to care and cardiovascular outcomes according to race, insurance, and socioeconomic status. The effect of insurance status upon the decision to use DES is unclear.
  
  
  METHODS
  Patients undergoing percutaneous coronary intervention (PCI) with stenting from April 2003 to June 2009, the so-called DES era, were retrospectively analyzed. Multivariable logistic regression was performed separately for patients <65 years and patients > or =65 years, with receipt of > or =1 DES during PCI as the outcome variable of interest. Insurance type was categorized as private, Medicare, Medicaid, and uninsured, based upon the primary insurance at discharge. Data regarding duration of clopidogrel therapy at 1 month, 6 months, and 1 year was also collected.
  
  
  RESULTS
  Among the 12,584 patients who underwent PCI with stenting, 6,157 (48.9%) had private insurance, 5,689 (45.2%) had Medicare, 467 (3.7%) had Medicaid, and 271 (2.2%) were uninsured at the time of hospital discharge. There were no significant differences by insurance type in duration of dual antiplatelet therapy at 1 year. Both multivariable logistic regressions showed that Medicaid patients (odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.46 to 0.78 for age <65 years; OR: 0.45; 95% CI: 0.24 to 0.85 for age > or =65 years) and patients without insurance (OR: 0.57; 95% CI: 0.42 to 0.78 for age <65 years; OR: 0.20; 95% CI: 0.05 to 0.86 for age > or =65 years) were less likely to receive DES.
  
  
  CONCLUSIONS
  Insurance status has a significant impact upon the decision to use DES. Efforts to address this disparity should focus on the patient-provider level.
authors.affiliation: Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Gonzalez
authors.forename: Sara D
authors.initials: SD
authors.lastname: Collins
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Asmir I
authors.initials: AI
authors.lastname: Syed
authors.forename: Gabriel
authors.initials: G
authors.lastname: Maluenda
authors.forename: Cedric
authors.initials: C
authors.lastname: Delhaye
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hanna
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kaneshige
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000295:instrumentation; D004219:District of Columbia; D016527:Drug Costs; D054855:Drug-Eluting Stents / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000191:economics; D017149:Private Sector / Q000191:economics*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors