Medicare Coverage Increases Odds of In-Hospital Mortality but Lack of Insurance Increases Odds of Poor Functional Outcome by Modified Rankin Score (mRS) (P2.138)

OBJECTIVE: We sought to analyze outcomes among stroke patients according to insurance coverage type. BACKGROUND: Ongoing health care reform highlights the link between insurance coverage and clinical outcomes. Recent findings demonstrate that lack of insurance correlates with poor outcomes in multiple conditions requiring hospital admission, including stroke. DESIGN/METHODS: All patients diagnosed with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) were retrospectively assessed from a single-center registry (6/08-8/13). Patients were excluded if insurance status was not documented. Insurance types were classified as no insurance, Medicare, Medicaid, private, VA, and >1 type. Univariate analyses and multivariate logistic regression were used with appropriate test statistics to determine if insurance status was an independent predictor of clinical outcome measures. RESULTS: Of the 1782 patients who met inclusion criteria, 11.5% were uninsured, 43.8% had Medicare, 9.2% had Medicaid, 19.6% had private insurance, and 6.5% had >1 type. Compared to uninsured and VA patients, Medicare patients had higher in-hospital death rate (10.26% vs. 6.86% and 4.71%, p=0.009) and lower rates of favorable functional outcome (mRS 0-2) (58.18% vs. 62.35% and 83.89%, p2) compared with all other insurance types. CONCLUSIONS: Medicare patients have greater odds of in-hospital mortality compared to uninsured, private, and VA patients, though uninsured patients had the highest odds of poor functional outcome on discharge. Further studies are needed to determine whether coverage is a stronger predictor of admission or in-hospital variables to determine if the observed outcome differences are more associated with variance in admission or in-hospital care. Disclosure: Dr. Friedant has nothing to disclose. Dr. Monlezun, Jr has nothing to disclose. Dr. Baranwal has nothing to disclose. Dr. Valmoria has nothing to disclose. Dr. Shaban has nothing to disclose. Dr. George has received research support from Tulane University School of Medicine. Dr. El Khoury has nothing to disclose. Dr. Martin-Schild has nothing to disclose.