Effect of Insurance and Racial Disparities on Outcomes in XXXX .

@entity1 @entity131 @entity130
UNASSIGNED: Introduction   We evaluated outcome and resource utilization disparities between commercially insured, Medicaid, and Medicare @entity1 . We further analyzed racial disparities in a subset cohort. Methods   We reviewed the MarketScan database (2000-2009) for adult @entity131 ( @entity131 ) @entity1 . Analyses were performed to evaluate outcome differences by insurance type and race. Outpatient service utilization disparities by insurance and race were also evaluated. Results   Our study included 92,159 @entity131 @entity1 , 44,108 (47.9%) of whom utilized commercial insurance, 19,743 (21.4%) utilized Medicaid, and 28,308 (30.7%) utilized Medicare. In-hospital mortality was lowest for commercially insured (5.0%) versus 7.6% and 8.5% for Medicaid and Medicare @entity1 , respectively (p   <   0.0001). Medicaid @entity1 had a longer hospitalization than commercially insured (12 days versus 6 days; p   <   0.0001). Medicaid @entity1 were 1.29 and 1.78 times more likely to die and experience complications than the commercially insured. Females had a lower mortality risk (odds ratio [OR]: 0.80, p   <   0.0001) and less complications (OR: 0.67; p   <   0.0001) than males. Higher comorbidities increased mortality risk (OR: 2.71; p   <   0.0001) and complications (OR: 2.96, p   <   0.0001). @entity130 @entity1 had lower mortality (OR: 0.01; p   <   0.0001) and less complications (OR: 0.07; p   <   0.0001). Medicare (OR: 1.33; p   <   0.0001) and higher comorbidity (OR: 1.26; p   <   0.0001) @entity1 utilized outpatient rehabilitation services more frequently. Medicare @entity1 had twice the emergency department visits as the commercially insured (p   <   0.0001). Medicare (16.6%) @entity1 utilized more rehabilitation than commercially insured (13.4%) and Medicaid (9.1%) @entity1 . Racial disparities were analyzed in a subset of 12,847 white and 4,780 African American (AA) @entity1 . Multivariate analysis showed that AAs were more likely to experience a complication than white @entity1 (OR: 1.13; p   =   0.0024) and less likely to utilize outpatient rehabilitation services (OR: 0.83; p   =   0.0025) than whites. Conclusions   Insurance and racial disparities continue to exist for @entity131 @entity1 . Insurance status appears to have an impact on short- and long-term outcomes to a greater degree than @entity1 race.
