title: Association of health insurance status with presentation and outcomes of coronary artery disease among nonelderly adults undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  The aim of this study was to determine if insurance status is associated with adverse outcomes in patients with coronary artery disease.
  
  
  METHODS
  A cohort of 13,456 patients who underwent percutaneous coronary intervention (PCI) between January 1, 2004, and December 31, 2007, at 4 New York State teaching hospitals was retrospectively studied. The primary outcome of interest was in-hospital mortality from any cause.
  
  
  RESULTS
  Of the 13,456 patients studied, 11,927 (88.6%) were insured by private carriers, 1,036 (7.7%) patients were covered by Medicaid, and 493 (3.7%) were uninsured. Uninsured and Medicaid patients tended to be younger and more often nonwhite and Hispanic. They had a higher prevalence of congestive heart failure and worse left ventricular function. Compared with privately insured patients, uninsured and Medicaid patients had increased all-cause mortality (1.2% and 0.9%, respectively, vs 0.3%; P < .001). For all patients, lack of insurance (OR 3.02, 95% CI 1.10-8.28) and Medicaid (OR 4.39, 95% CI 1.93-9.99) were independently associated with mortality. Lack of insurance (OR 5.02, 95% CI 1.58-15.93) and Medicaid (OR 4.55, 95% CI 1.19-17.45) were also independently associated with increased mortality in patients undergoing emergent PCI.
  
  
  CONCLUSIONS
  Lack of insurance and Medicaid insurance are both independently associated with an increased risk of in-hospital mortality after PCI for coronary artery disease.
authors: Department of Medicine, Division of Cardiovascular Medicine, State University of New York, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors: Puja B
authors: PB
authors: Parikh
authors: Luis
authors: L
authors: Gruberg
authors: Allen
authors: A
authors: Jeremias
authors: John J
authors: JJ
authors: Chen
authors: Srihari S
authors: SS
authors: Naidu
authors: Richard A
authors: RA
authors: Shlofmitz
authors: Sorin J
authors: SJ
authors: Brener
authors: Thomas
authors: T
authors: Pappas
authors: Kevin P
authors: KP
authors: Marzo
authors: David L
authors: DL
authors: Brown
mesh_terms: D000367:Age Factors; D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D002423:Cause of Death / Q000639:trends; D003324:Coronary Artery Disease / Q000191:economics* / Q000401:mortality / Q000628:therapy; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006784:Hospitals, Teaching; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends