Evidence map›Paper›PMID 31449681›Full record

ArticleJournal of the American Geriatrics Society2019

Health Insurance and Disparities in Mortality among Older Survivors of Critical Illness: A Population Study.

Yoland F Philpotts, Xiaoyue Ma, Michaela R Anderson, May Hua, Matthew R Baldwin

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Geriatrics Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Yoland F PhilpottsDivision of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Xiaoyue MaDepartment of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Michaela R AndersonDivision of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
May HuaDepartment of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Matthew R BaldwinDivision of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.ORCID 0000-0003-4670-3433

Funding

Clinical and Translational Science AwardUL1TR001873 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI REILLY, MUREDACH P · 2016 to 2025
$99.0M
Determinants of Critical Care Intensity for Hospitalized Older Adults: the Effect of Hospital-based Palliative Care ServicesK08AG051184 · NIA · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI HUA, MAY · 2015 to 2019
$863k
Frailty, Palliative Care Needs, and Outcomes in Older Survivors of Critical IllneK23AG045560 · NIA · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI BALDWIN, MATTHEW R · 2014 to 2018
$750k
Columbia University Aging Center at the Mailman School of Public Health Faculty FellowshipNCATS NIH HHS UL1 TR001873NIA NIH HHS K08 AG051184NIA NIH HHS K23 AG045560NIA NIH HHS L30 AG053861
6 · The paper itself

Abstract

objectivesThe 1.5 million Medicare beneficiaries who survive intensive care each year have a high post-hospitalization mortality rate. We aimed to determine whether mortality after critical illness is higher for Medicare beneficiaries with Medicaid compared with those with commercial insurance.

designA retrospective cohort study from 2010 through 2014 with 1 year of follow-up using the New York Statewide Planning and Research Cooperative System database.

settingA New York State population-based study of older (age ≥65 y) survivors of intensive care.

participantsAdult Medicare beneficiaries age 65 years or older who were hospitalized with intensive care at a New York State hospital and survived to discharge.

interventionNone. MEASUREMENT: Mortality in the first year after hospital discharge.

resultsThe study included 340 969 Medicare beneficiary survivors of intensive care with a mean (standard deviation) age of 77 (8) years; 20% died within 1 year. There were 152 869 (45%) with commercial insurance, 78 577 (23%) with Medicaid, and 109 523 (32%) with Medicare alone. Compared with those with commercial insurance, those with Medicare alone had a similar 1-year mortality rate (adjusted hazard ratio [aHR] = 1.01; 95% confidence interval [CI] = .99-1.04), and those with Medicaid had a 9% higher 1-year mortality rate (aHR = 1.09; 95% CI = 1.05-1.12). Among those discharged home, the 1-year mortality rate did not vary by insurance coverage, but among those discharged to skilled-care facilities (SCFs), the 1-year mortality rate was 16% higher for Medicaid recipients (aHR = 1.16; 95% CI = 1.12-1.21; P for interaction <.001).

conclusionsOlder adults with Medicaid insurance have a higher 1-year post-hospitalization mortality compared with those with commercial insurance, especially among those discharged to SCFs. Future studies should investigate care disparities at SCFs that may mediate these higher mortality rates. J Am Geriatr Soc 67:2497-2504, 2019.

Indexed as

Critical IllnessHealthcare DisparitiesAgedAged, 80 and overFemaleHospitalizationHumansInsurance CoverageInsurance, HealthMaleMedicaidMedicareMortalityNew YorkPatient DischargeRetrospective Studiescritical illnessinsurance coverageskilled nursing facilities

Identifiers

PMID31449681
PMCPMC7208434

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.