Uninsured patients undergoing craniotomy for brain tumor have higher in-hospital mortality

http://www.eurekalert.org/pub_releases/2012-11/jaaj-upu111512.php

Public release date: 19-Nov-2012
Contact: Stephanie Desmon
JAMA and Archives Journals

CHICAGO – Compared to insured patients, uninsured patients have higher in-hospital mortality following surgery for brain tumors, according to a report published in the November issue of Archives of Surgery, a JAMA Network publication.

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"Among patients with brain tumors with no other major medical condition, uninsured patients (but not necessarily Medicaid recipients) have higher in-hospital mortality than privately insured patients, a disparity that was pronounced in teaching hospitals. These findings further reinforce prior data indicating insurance-related disparities in medical and surgical settings," the authors comment.

The mortality rate for privately insured patients was 1.3 percent compared with 2.6 percent for uninsured patients and 2.3 percent for Medicaid recipients in an unadjusted statistical analysis. After adjusting for patient characteristics and stratifying (classifying) by hospital in patients with no co-existing illnesses, uninsured patients still had a higher risk of in-hospital death (hazard ratio, 2.62) compared with privately insured patients. In the adjusted analysis, being a Medicaid recipient was "not definitively" associated with higher in-hospital mortality compared with private insurance, according to the study results.

"Uninsured patients undergoing craniotomy for a brain tumor experience worse outcomes than privately insured patients, and this difference is pronounced in teaching hospitals. This variation in postoperative outcomes remains unexplained by hospital characteristics, including clustering effects, comorbid disease, or socioeconomic variations," the authors conclude. "This study did not exclude the possibilities that comorbid conditions are underdiagnosed in uninsured patients or that uninsured patients are presenting with more advanced stages of the disease."