(503) Insurance Status and COVID-19 Outcomes: Observations From the National Inpatient Sample Database

Introduction: The COVID-19 pandemic has imposed a significant financial burden on individuals and the US healthcare system. Early estimates have shown that average billing costs for noncomplex COVID-19 hospitalizations vary from $31,339 to $111,213 across the country. This study aims to investigate the influence of insurance status on clinical outcomes in patients hospitalized with COVID-19 infection.

Methods: Using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database for 2020, we identified adult patients hospitalized with COVID-19 infection as the primary admitting diagnosis. Insurance status was categorized into three groups: Medicare, private insurance, and under/uninsured (including Medicaid and self-pay patients). The primary outcome was in-hospital mortality. Secondary outcomes included the need for non-invasive, invasive, and early mechanical ventilation within 24 hours of hospitalization, length of stay, and total hospitalization charges. We performed univariate and multivariable analyses, adjusted for confounding factors such as age, gender, race, median income of the patient's zip code, comorbidity burden, hospital region, size, location, and teaching status. Data analysis was performed using Stata (StataCorp; College Station, TX).

Results: Compared to patients with Medicare, under/uninsured patients demonstrated higher in-hospital mortality (OR 1.11, 95% CI 1.04-1.18, p-value 0.002). In addition, under/uninsured patients were more likely to undergo intubation and mechanical ventilation, particularly within 24 hours of hospitalization. Patients with private insurance or under/uninsured status also experienced longer lengths of stay and higher average hospitalization charges than patients with Medicare.

Conclusions: Our study reveals that insurance status significantly impacted clinical outcomes in COVID-19-associated hospitalizations. These findings suggest that cost-related barriers to healthcare access may exist for certain patient populations, particularly the under/uninsured. Equitable access to care is crucial in a pandemic to reduce disease burden. Further investigation is warranted to identify and address these disparities to provide equal access to care for all individuals regardless of insurance status.