ArticleJournal of the American College of Cardiology2013
Treatment differences by health insurance among outpatients with coronary artery disease: insights from the national cardiovascular data registry.
Article in Journal of the American College of Cardiology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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Who cites it
22 citing papers in PubMed, 42 citations in OpenAlex.
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- Coverage and Access for Americans with Cardiovascular Disease or Risk Factors After the ACA: a Quasi-experimental Study.Journal of general internal medicine · 2019Article
- The Disparities of Coronary Artery Bypass Grafting Surgery Outcomes by Insurance Status: A Retrospective Cohort Study, 2007-2014.World journal of surgery · 2018Article
- Awareness of Cardiovascular Risk Factors in U.S. Young Adults Aged 18-39 Years.American journal of preventive medicine · 2018Article
- Cardiovascular Medicine Amid Evolving Health Policy: Time to Train a Generation of Policy Leaders.Journal of the American College of Cardiology · 2017Article
- Vulnerabilities to Health Disparities and Statin Use in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study.Journal of the American Heart Association · 2017Article
- Article
- Demographic analysis of a low resource, socioculturally diverse urban community presenting for infertility care in a United States public hospital.Contraception and reproductive medicine · 2017Article
- Have health insurance reforms in Tunisia attained their intended objectives?International journal of health economics and management · 2015Article
- Finding medical care for colorectal cancer symptoms: experiences among those facing financial barriers.Health education & behavior : the official publication of the Society for Public Health Education · 2015Article
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Authors and funding
7 authors at 5 institutions in 2 countries.
Funding
Abstract
objectivesThis study examined the association between insurance status and physicians' adherence with providing evidence-based treatments for coronary artery disease (CAD).
methodsWithin the PINNACLE (Practice Innovation and Clinical Excellence) registry of the NCDR (National Cardiovascular Data Registry), the authors identified 60,814 outpatients with CAD from 30 U.S. practices. Hierarchical modified Poisson regression models with practice site as a random effect were used to study the association between health insurance (no insurance, public, or private health insurance) and 5 CAD quality measures.
resultsOf 60,814 patients, 5716 patients (9.4%) were uninsured and 11,962 patients (19.7%) had public insurance, whereas 43,136 (70.9%) were privately insured. After accounting for exclusions, uninsured patients with CAD were 9%, 12%, and 6% less likely to receive treatment with a beta-blocker, an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACE-I/ARB), and lipid-lowering therapy, respectively, than privately insured patients, and patients with public insurance were 9% less likely to be prescribed ACE-I/ARB therapy. Most differences by insurance status were attenuated after adjusting for the site providing care. For example, whereas uninsured patients with left ventricular dysfunction and CAD were less likely to receive ACE-I/ARB therapy (unadjusted RR: 0.88; 95% CI: 0.84 to 0.93), this difference was eliminated after adjustment for site (adjusted RR: 0.95; 95% CI: 0.88 to 1.03; p = 0.18).
conclusionsWithin this national outpatient cardiac registry, uninsured patients were less likely to receive evidence-based medications for CAD. These disparities were explained by the site providing care. Efforts to reduce treatment differences by insurance status among cardiac outpatients may additionally need to focus on improving the rates of evidence-based treatment at sites with high proportions of uninsured patients.
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