Risk of health morbidity for the uninsured: 10-year evidence from a large hospital center in Boston, Massachusetts

Objective: To investigate the independent contribution of insurance status toward the risk of diagnosis of specific clinical comorbidities for individuals admitted to intensive care unit (ICU). Design: Retrospective analysis of secondary database. Setting: Ten years of public de-identified ICU electronic medical records from a large hospital in USA. Participants: Patients (18-65 years old) who had private insurance or no insurance were extracted from the database. Main outcome measures: Independent association of insurance status (uninsured vs. privately insured) with the risk of diagnosis of specific clinical comorbidities. Results: Among 14 268 (from 11 753 patients) admissions to ICU between 2001 and 2012, 96% of them were covered by private insurance. Patients with private insurance had higher proportion of females, married, White race, longer ICU stay and more procedures during stay, and fewer deaths. A lower CCI was observed in uninsured patients. At multivariable analysis, uninsured patients had higher odds of death and of admissions for accidental falls, substance or alcohol abuse. Conclusions: Patients with no insurance coverage were at higher risk of death and of admission for physical and substance-related injury. We did not observe a higher risk for acute lifethreatening diseases such as myocardial infarction or kidney failure. The lower CCI observed in the uninsured may be explained by under diagnosis or voluntary withdrawal from coverage in the pre-Affordable Care Act era. Replication of findings is warranted in other populations, among those with government-subsidized insurance and in the procedure/prescription domains.