Association of Insurance Status and Hospital Admission and Mortality in Patients with Type 1 Diabetes Mellitus Open Access
Van Curen, Adrienne (Summer 2024)
Abstract
Abstract
Association of Insurance Status and Hospital Admission and Mortality in Patients with Type 1 Diabetes Mellitus
By Adrienne Van Curen, MD
Background: The healthcare landscape is continuously evolving, particularly for chronic diseases, and has profound implications on patient outcomes and healthcare delivery systems. For patients with type 1 diabetes mellitus (T1DM) insurance status significantly influences access to care and management technologies. The existing literature has several limitations: it predominantly pre-dates changes by Medicaid to increase access to diabetes technology in 2017; it often fails to differentiate between patients with type 1 versus type 2 diabetes mellitus; and it underrepresents patients without regular specialty care of their diabetes.
Objective: To investigate the correlation between insurance coverage and the likelihood of hospital admission or death for T1DM patients presenting to emergency departments, with a focus on the differential impacts of public versus private insurance sectors.
Methods: This cross-sectional study utilized secondary data from the 2019 Nationwide Emergency Department Sample (NEDS), including a weighted population of 772,911 patients with T1DM, identified by ICD-10-CM diagnosis. Logistic regression models were applied to assess the odds of hospital admission or death based on insurance status-defined as private, public, self-pay, or other-while adjusting for demographic variables including age, race, and urbanicity of the patient residence.
Results: Patients with public insurance or who were self-pay had a 27% higher risk of hospital admission or death compared to those with private insurance. Pediatric patients with public insurance or no insurance had lower odds of hospitalization or death compared to pediatric patients with private insurance. Patients with public insurance or who were self-pay had higher odds of leaving the emergency department (ED) against medical advice (AMA). Furthermore, living in less urban areas was associated with lower odds of severe outcomes.
Conclusion: Insurance status is strongly associated with healthcare outcomes for patients with T1DM. In this study, the higher odds of hospital admission or death were similarly elevated for both patients with public insurance and those without insurance compared to patients with private insurance suggesting that not only insurance, but insurance type, may be critical. As public health insurance coverage evolves for patients with T1DM, it will be important to periodically re-evaluate these findings. Given the notable results in pediatric patients and those who left the ED AMA, further investigation in these specific groups is warranted.
Table of Contents
Table of Contents
Chapter 1: Introduction
1.1 Significance.……………………………………………………………………1
1.2 Problem Statement..…………………………………………………………1
1.3 Theoretical Framework…………………………………………………….1
1.4 Purpose Statement…………………………………………………………..4
1.5 Research Question……………………………………………………………4
1.6 Significance Section..………………………………………………………..5
1.7 Definition of Terms……………………………………………………………5
Chapter 2: Review of the Literature
2.1 Introductory Paragraph…………………………………………………….7
2.2 Body……….………………………………………………………………………7
2.3 Summary of Current Problem and Study Relevance………….11
Chapter 3: Methodology
3.1 Introduction..……………………………………………………………………12
3.2 Data Sources…………….…………………………………………………….12
3.3 Patient Population & Variable Definitions…………………………….12
3.4 Data Analysis…………………………………………………………………..13
Chapter 4: Results
4.1 Key Findings……………………………………………………………………..16
4.2 Summary……………………………………………………………………….21
Chapter 5: Conclusions, Implications, and Recommendations
5.1 Summary of Study..…………………………………………………………..23
5.2 Discussion of Key Results.…………………………………………………24
5.3 Limitations and Strengths.………………………………………………..26
5.4 Implications..…………………………………………………………………….27
5.5 Recommendations..………………………………………………………….28
5.6 Conclusion.……………………………………………………………………….29
References
Appendix
About this Master's Thesis
| School | |
|---|---|
| Department | |
| Subfield / Discipline | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Keyword | |
| Committee Chair / Thesis Advisor | |
| Committee Members |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Association of Insurance Status and Hospital Admission and Mortality in Patients with Type 1 Diabetes Mellitus () | 2024-04-09 11:59:37 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|