Role of Health Insurance Status in Interfacility Transfers of Patients With ST-Elevation Myocardial Infarction.
Lack of health insurance is associated with interfacility transfer from emergency departments for several nonemergent conditions, but its association with transfers for ST-elevation myocardial infarction (STEMI), which requires timely definitive care for optimal outcomes, is unknown. Our objective was to determine whether insurance status is a predictor of interfacility transfer for emergency department visits with STEMI. We analyzed data from the 2006 to 2011 Nationwide Emergency Department Sample examining all emergency department visits for patients age 18 years and older with a diagnosis of STEMI and a disposition of interfacility transfer or hospitalization at the same institution. For emergency department visits with STEMI, our multivariate logistic regression model included emergency department disposition status (interfacility transfer vs hospitalization at the same institution) as the primary outcome, and insurance status (none vs any [including Medicare, Medicaid, and private insurance]) as the primary exposure. We found that among 1,377,827 emergency department STEMI visits, including 249,294 (18.1%) transfers, patients without health insurance (adjusted odds ratio 1.6, 95% CI 1.5 to 1.7) were more likely to be transferred than those with insurance. Lack of health insurance status was also an independent risk factor for transfer compared with each subcategory of health insurance, including Medicare, Medicaid, and private insurance. In conclusion, among patients presenting to United States emergency departments with STEMI, lack of insurance was an independent predictor of interfacility transfer. In conclusion, because interfacility transfer is associated with longer delays to definitive STEMI therapy than treatment at the same facility, lack of health insurance may lead to important health disparities among patients with STEMI.
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee. Electronic address: michael.j.ward@vanderbilt.edu.
Michael J
MJ
Ward
Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Center for Clinical Quality and Implementation Research, Vanderbilt University School of Medicine, Nashville, Tennessee.
Sunil
S
Kripalani
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Yuwei
Y
Zhu
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Alan B
AB
Storrow
Division of Cardiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
Thomas J
TJ
Wang
Geriatric Research, Education, and Clinical Center, Department of Medicine, VA Tennessee Valley Healthcare System, Nashville, Tennessee.
Theodore
T
Speroff
Division of Cardiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
Daniel
D
Munoz
Geriatric Research, Education, and Clinical Center, Department of Medicine, VA Tennessee Valley Healthcare System, Nashville, Tennessee; Department of Medicine, Institute for Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, Tennessee.
Robert S
RS
Dittus
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Frank E
FE
Harrell
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Wesley H
WH
Self
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction; D014481:United States; D055815:Young Adult