Increased Risk of Death among Uninsured Neonates

• Published in: Health services research 2013-08, Vol.48 (4), p.1232-1255
• Main Author: Morriss Jr, Frank H.
• Format: Article
• Language: English
• Subjects: Child welfare; Death; Female; Health aspects; Health care delivery; Health insurance; Health risk assessment; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - statistics & numerical data; Hospital Charges - statistics & numerical data; Hospital Mortality; Hospitals; Humans; Infant Mortality; Infant, Newborn; Infants; insurance; Insurance Coverage - statistics & numerical data; Intensive Care Units, Neonatal - statistics & numerical data; Length of Stay - statistics & numerical data; Logistic Models; Male; Medical research; Medically Uninsured - statistics & numerical data; Medically uninsured persons; Mortality; Multivariate Analysis; Neonatal care; neonate; Newborn babies; Patient outcomes; Patient Transfer - statistics & numerical data; Public health; Quality and Outcomes; Quality of care; Regression analysis; Resource Allocation - statistics & numerical data; Retrospective Studies; Risk Factors; Rural communities; Studies; Uninsured patients; Uninsured people; United States - epidemiology
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12042

Objective To estimate the contribution of health insurance status to the risk of death among hospitalized neonates. Data Sources Kids' Inpatient Databases (KID) for 2003, 2006, and 2009. Study Design KID 2006 subpopulation of neonatal discharges was analyzed by weighted frequency distribution and multivariable logistic regression analyses for the outcome of death, adjusted for insurance status and other variables. Multivariable linear regression analyses were conducted for the outcomes mean adjusted length of stay and hospital charges. The death analysis was repeated with KID 2003 and 2009. Principal Findings Of 4,318,121 estimated discharges in 2006, 5.4 percent were uninsured. There were 17,892 deaths; 9.5 percent were uninsured. The largest risks of death were five clinical conditions with adjusted odds ratios (AOR) of 13.7–3.1. Lack of insurance had an AOR of 2.6 (95 percent CI: 2.4, 2.8), greater than many clinical conditions; AOR estimates in alternate models were 2.1–2.7. Compared with insureds, uninsureds were less likely to have been admitted in transfer, more likely to have died in rural hospitals and to have received fewer resources. Similar death outcome results were observed for 2003 and 2009. Conclusions Uninsured neonates had decreased care and increased risk of dying.