Association of Health Insurance Status with Outcomes of Sepsis in Adult Patients: A Retrospective Cohort Study

Abstract

(1) Background: Sepsis is a life-threatening disease, and various demographic and socioeconomic factors affect outcomes in sepsis. However, little is known regarding the potential association between health insurance status and outcomes of sepsis in Korea. We evaluated the association of health insurance and clinical outcomes in patients with sepsis. (2) Methods: Prospective cohort data of adult patients with sepsis and septic shock from March 2016 to December 2018 in three hospitals were retrospectively analyzed. We categorized patients into two groups according to their health insurance status: National Health Insurance (NHI) and Medical Aid (MA). The primary end point was in-hospital mortality. The multivariate logistic regression model and propensity score matching were used. (3) Results: Of a total of 2526 eligible patients, 2329 (92.2%) were covered by NHI, and 197 (7.8%) were covered by MA. The MA group had fewer males, more chronic kidney disease, more multiple sources of infection, and more patients with initial lactate > 2 mmol/L. In-hospital, 28-day, and 90-day mortality were not significantly different between the two groups and in-hospital mortality was not different in the subgroup analysis. Furthermore, health insurance status was not independently associated with in-hospital mortality in multivariate analysis and was not associated with survival outcomes in the propensity score-matched cohort. (4) Conclusion: Our propensity score-matched cohort analysis demonstrated that there was no significant difference in in-hospital mortality by health insurance status in patients with sepsis.

Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis

“…The 28- or 30-day mortality from sepsis diagnosed using the Sepsis-3 criteria was 22.7% (95% confidence interval [CI], 20.0%–25.6%; I 2 =89%) ( Table 2 and Fig. 2 ) [ 15 , 17 , 21 , 26 , 27 , 35 , 39 , 42 , 46 , 50 , 55 – 59 , 69 , 72 ]. The range of mortality in the included studies was 14.4% to 40.8%.…”

“…In addition, the 28- or 30-day mortality rate by including all sepsis criteria was 24.8% (95% CI, 22.1%–27.7%; I 2 =95%) ( Supplementary Fig. 1 ) [ 15 , 17 , 20 , 21 , 26 , 27 , 29 – 31 , 34 , 35 , 39 , 42 , 44 , 46 , 50 , 55 – 59 , 63 , 69 , 71 , 72 , 74 ]. In the subgroup analyses, 28- or 30-day mortality from sepsis was 22.6% (95% CI, 19.5%–25.9%; I 2 =94%) in retrospective cohort studies, 29.1% (95% CI, 23.4%–35.5%; I 2 =96%) in prospective studies, 23.3% (95% CI, 20.5%–26.5%; I 2 =93%) in single-center studies, and 31.3% (95% CI, 23.4%–40.4%; I 2 =98%) in multicenter studies ( Table 2 ).…”

“…In-hospital mortality from sepsis diagnosed using the Sepsis-3 criteria was 28.1% (95% CI, 25.2%–31.1%; I 2 =87%) ( Table 2 and Fig. 3 ) [ 15 , 17 , 26 – 28 , 32 , 33 , 39 , 41 , 47 , 50 , 59 , 72 ]. The range of mortality was 15.7% to 47.0%.…”

救急搬送された尿路感染症患者における菌血症および敗血症性ショックを予測する因子の検討(Analysis of predictors for bacteremia and septic shock in patients with urinary tract infection transported to hospital by ambulance)

“…尿路感染症と診断された患者に対して，血液培養施行率が97.8%と高いにもかかわらず，血液培養陽性率が39.7%と一般的陽性率20%台に比べて高かった 3)。全例に近い培養施行状況での高い陽性率には2つの要因が考えられる。1つは救急搬送患者の社会経済的要因で，当院は無料低額診療事業 9)を実施しており，救急搬送されたケースでの無料低額診療の実施率が2%と多くはないが，生活保護受給者も多く生活困窮者の搬送が同事業不採用の救急病院に比べて多い。基礎疾患を有していても医療アクセスがない，通院していても服薬アドヒアランスが低く原病のコントロールが不良である，基礎疾患によらず栄養状態が悪いなど，療養環境や生活背景の破綻状態が高い培養陽性率に関与していると推測される 10), 11)。2つ目の要因として，一般の救急病院では敬遠されがちなパフォーマンスステータス（PS）が悪い有熱高齢患者を，調査期間中に当たる2020年2月中旬からの新型コロナウイルス感染症アウトブレイク後も可能な限り受け入れていたことが考えられる。…”