Inequalities in accessing quality healthcare, does insurance play a role? retrospective analysis of aortic emergencies from national inpatient sample 2019

Abstract Background Aortic emergencies, dissection and rupture, are rare but catastrophic entities, with the cornerstone to survival being prompt diagnosis treatment. Insurance status often limits access healthcare, our study aims determine if it plays a role in outcomes of aortic emergencies. Method A retrospective analysis 2019 Nationwide Inpatient Sample was conducted identify hospitalization (Age ≥18 & non-elective) ruptured aneurysms using ICD-10 codes. Discharge-level weight used produce national estimate. Variables were screened univariate regression, intermediate co-linear variables screened-out before multivariable regression model built performed calculate odds ratio. Results total 19,685 (0.06%) hospitalizations identified for emergencies (14965 dissections 4720 aneurysms). The mean age 58.56, 62.7% males, ethnic distribution 65.1% white, 19.5% blacks, 7.6% Hispanics, others. 11.4% underwent diagnostic imaging either CTA/MRA/TEE/Aortography within 24 hours. Hypotension/shock present 32% these risk factor mortality OR 3.21 (p<0.00), increasing LOS by an average 5.1 days resource utilization 156,000$. Another stroke/TIA (OR-1.76, p<0.00), 3.1 80,662$, respectively. 3220 (16.4%) did not survive course, rate uninsured, Medicare, Medicaid 17%, 20%,9% compared 12% privately insured. On crude analysis, uninsured medicare patients appeared have higher [OR 1.50, p<0.04, 1.83 p-value <0.002 respectively], however upon adjusting confounders, only showed statistically significant difference (OR 2.13, p<0.002). Similar results corroborated on analyzing dissection; however, insurance influence aneurysm. When comparing median household income ≥79,000$ 59,000–78,999 $, 46,000–58,999 $ <46,000$ had (OR-1.38, p<0.04), (OR-1.44, p<0.02) p<0.03) Of all types, private insurance, average, 2.8 more incurred additional 62,912$ (p<0.00). Conclusion Inequalities accessing income, factors Efforts needed bridge gap this particular facet social determinants health find sustainable equitable solution quality healthcare aall regardless their status. Funding Acknowledgement Type funding sources: None.