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Insurance Status May Explain Racial Disparity for Heart Deaths


A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health found that a patient’s level of health insurance coverage was a better predictor of survival from a heart attack or stroke than was race. A sampling of hospitals in Maryland found that cardiac and stroke patients who were underinsured were more likely to die following admission to a hospital, even after accounting for race and socioeconomic factors. The findings, published online in the Journal of General Internal Medicine, may help explain racial disparities in health outcomes for cardiovascular disease in the U.S.

“African Americans living in poor, urban neighborhoods bear a high burden of illnesses and early death, from cardiovascular disease in particular,” said Derek Ng, ScM, lead author of the study and graduate student in Bloomberg School’s Department of Epidemiology. “Our findings suggested that a lack of health insurance, or being underinsured is a major cause of insufficient treatment and subsequent premature death.”

Ng and colleagues examined nearly 13,000 patient records from three Maryland hospitals treating low-, middle- and high-income patients. Patients included in the analysis were admitted to the hospital for acute myocardial infarction (heart attack), coronary atherosclerosis or stroke.

After accounting for the potential effects of neighborhood socioeconomic status and disease severity, the researchers found that underinsured patients died sooner than patients with private insurance, whereas the survival rates were comparable between whites and blacks. More specifically, underinsured patients had a 31 percent higher risk of early death after a heart attack and a 50 percent higher risk after atherosclerosis. This survival effect was independent of race, neighborhood socioeconomic status and disease severity.

"Among those admitted to the hospital with an acute cardiovascular event, there was an increased risk of mortality among subjects who were underinsured compared to those who had private insurance,” said co-author J. Hunter Young, MD, MHS, assistant professor with the Bloomberg School of Public Health and the Johns Hopkins School of Medicine. “Given the recent changes in health insurance and healthcare reform, these results underscore the need to closely investigate the factors relating to health insurance that may explain these disparities. Indeed, targeting these factors may relieve the burden of mortality disproportionally affecting those who are underinsured."

The authors of “Insurance status, not race, is associated with mortality after an acute cardiovascular event in Maryland” are Derek K. Ng, ScM; Daniel J. Brotman, MD; Bryan Lau, PhD, MHS, ScM; and J. Hunter Young, MD, MHS.

The researchers were supported by funding from the Johns Hopkins Bloomberg School of Public Health.

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