Race, Ethnicity, Health Insurance, and Mortality in Older Survivors of Critical Illness.
OBJECTIVE
To determine whether minority race or ethnicity is associated with mortality and mediated by health insurance coverage among older (≥ 65 yr old) survivors of critical illness.


METHODS
A retrospective cohort study.


METHODS
Two New York City academic medical centers.


METHODS
A total of 1,947 consecutive white (1,107), black (361), and Hispanic (479) older adults who had their first medical-ICU admission from 2006 through 2009 and survived to hospital discharge.


METHODS
None.


RESULTS
We obtained demographic, insurance, and clinical data from electronic health records, determined each patient's neighborhood-level socioeconomic data from 2010 U.S. Census tract data, and determined death dates using the Social Security Death Index. Subjects had a mean (SD) age of 79 years (8.6 yr) and median (interquartile range) follow-up time of 1.6 years (0.4-3.0 yr). Blacks and Hispanics had similar mortality rates compared with whites (adjusted hazard ratio, 0.92; 95% CI, 0.76-1.11 and adjusted hazard ratio, 0.92; 95% CI, 0.76-1.12, respectively). Compared to those with commercial insurance and Medicare, higher mortality rates were observed for those with Medicare only (adjusted hazard ratio, 1.43; 95% CI, 1.03-1.98) and Medicaid (adjusted hazard ratio, 1.30; 95% CI, 1.10-1.52). Medicaid recipients who were the oldest ICU survivors (> 82 yr), survivors of mechanical ventilation, and discharged to skilled-care facilities had the highest mortality rates (p-for-interaction: 0.08, 0.03, and 0.17, respectively).


CONCLUSIONS
Mortality after critical illness among older adults varies by insurance coverage but not by race or ethnicity. Those with federal or state insurance coverage only had higher mortality rates than those with additional commercial insurance.
1Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY. 2Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY. 3Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical Center, New York, NY. 4Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY. 5Division of Cardiology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY. 6Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
Matthew R
MR
Baldwin
Jessica L
JL
Sell
Nina
N
Heyden
Azka
A
Javaid
David A
DA
Berlin
Wendy C
WC
Gonzalez
Peter B
PB
Bach
Mathew S
MS
Maurer
Gina S
GS
Lovasi
David J
DJ
Lederer
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D017741:Survivors; D014481:United States