Uninsured patients with acute spine trauma may undergo fewer resource-intensive procedures
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CHICAGO — Patients who have acute spine trauma without insurance may receive fewer resource-intensive procedures, such as operative fixation or MRI imaging, compared with patients who have insurance, according to results presented here.
“Certainly, the clinical outcomes are worse with uninsured status, and the disparities in the workup, in terms of the diagnostic and therapeutic procedures that they obtained, may be contributing to the worsening outcomes,” Sanket Mehta, BA, said in his presentation at the North American Spine Society Annual Meeting.
Using the National Trauma Data Bank between 2011 and 2019, Mehta and colleagues performed a multivariate logistic analysis to investigate the association of insurance status with mortality and probability of undergoing CT scan, MRI scan of the spine, plain radiography, packed red blood cell transfusion within 4 hours, operative intervention and withdraw of care among patients aged 18 to 64 years with acute spine trauma. Researchers adjusted the multivariate logistic analysis for age, sex, race, ethnicity, injury severity score, presence of shock, mechanism of injury, intent of injury, Glasgow Coma Scale motor score, significantly different comorbidities and year of admission. In addition, researchers collected clinical outcomes, including post-surgical complications, in-hospital mortality and discharge.
“Insurance status was defined as: uninsured patients being the ones with self-pay; and other private and government insurance were classified as insured patients,” Mehta said.
Among the patients included in the study, Mehta noted 80% were insured and about 20% were uninsured.
“Patients without insurance were more likely to be younger, male and Hispanic or Latino,” Mehta said. “There were no differences in the injury severity scale despite differences in the mechanism in which these injuries occurred and, lastly, uninsured patients were more likely to present in shock compared to their insured counterparts.”
Bivariate analysis showed patients who did not have insurance had higher mortality rates and were less likely to experience any complication during hospitalization. Mehta noted uninsured status was an independent predictor of increased in-hospital mortality and cardiac arrest during hospitalization.
“In terms of procedure administration, we found that uninsured status was independently associated with decreased utilization of more resource-intensive studies, such as MRI,” Mehta said.
After adjusting for significant differences at baseline between the insured and uninsured groups, he added patients who were not insured were less likely to undergo operative fixation of the spine, were more likely to undergo CT imaging of the spine and were more likely to be withdrawn from care.
“About 45% of patients were evaluated at level-1 trauma centers where, here again, we saw that uninsured patients were less likely to undergo operative spinal fixation and had increased likelihood of receiving CT,” Mehta said. “Interestingly, there were no disparities in MRI imaging in this context.”
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Mehta S, et al. Paper 98. Presented at: North American Spine Society Annual Meeting; Oct. 12-15, 2022; Chicago.
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