Analysis of 23 million US hospitalizations: Uninsured children have higher all-cause in-hospital mortality

Background: The number of uninsured children in the USA is increasing while the impact on children's health of being uninsured remains largely uncharacterized. We analyzed data from more than 23 million US children to evaluate the effect of insurance status on the outcome of US pediatric hospitalization. Methods: In our analysis of two well-known large inpatient databases, we classified patients less than 18 years old as uninsured (self-pay) or insured (including Medicaid or private insurance). We adjusted for gender, race, age, geographic region, hospital type, admission source using regression models. In-hospital death was the primary outcome and secondary outcomes were hospital length of stay and total hospital charges adjusted to 2007 dollars. Results: The crude in-hospital mortality was 0.75 for uninsured versus 0.47 for insured children, with adjusted mortality rates of 0.74 and 0.46, respectively. On multivariate analysis, uninsured compared with insured patients had an increased mortality risk (odds ratio: 1.60, 95 CI: 1.45-1.76). The excess mortality in uninsured children in the US was 37.8, or 16 787, of the 38 649 deaths over the 18 period of the study. Conclusion: Children who were hospitalized without insurance have significantly increased all-cause in-hospital mortality as compared with children who present with insurance.