Hospitalizations for inflammatory bowel disease: Profile of the uninsured in the United States

Geoffrey C. Nguyen, Justina Sam, Sanjay K. Murthy, Gilaad G. Kaplan, Jill M. Tinmouth, Thomas A. LaVeist

Research output: Contribution to journalArticle

Abstract

Background: Inflammatory bowel disease (IBD) patients may be at increased risk for having no health insurance. Our objectives were to assess the prevalence of hospitalized IBD patients without insurance in the US and to characterize predictive factors. Methods: We identified IBD admissions in the Nationwide Inpatient Sample (1999-2005) and a 1% sample of general medical patients. We used population estimates from the US Census Bureau to calculate hospitalization rates, and logistic regression to determine predictors of being uninsured. Results: Although uninsured IBD patients were less likely to be hospitalized than those privately insured (incidence rate ratio [IRR] 0.41; 95% confidence interval [CI]: 0.38-0.45), their hospitalization rate increased from 8.3/100,000 to 12.5/100,000 (P <0.001) over 7 years, outpacing private admissions. The proportion of uninsured IBD inpatients increased from 4.6% to 6.5% (P <0.001), and IBD patients were more likely than general medical patients to be uninsured (5.1% vs. 4.1%, P a 0.0001). Predictors of being uninsured were being 21 to 40 years (odds ratio [OR] 1.95; 95% CI: 1.64-2.31), African American (OR 1.51; 95% CI: 1.29-0.76) or Hispanic (OR 2.21; 95% CI: 1.79 -2.74), or residing in the southern US (OR 1.63; 95% CI: 1.27-2.11). Being female (OR 0.65; 95% CI: 0.61-0.70), residing in higher income neighborhoods (OR 0.69; 95% CI: 0.62- 0.77), and higher comorbidity were protective factors. Conclusions: The rate of uninsured IBD admissions has risen disproportionately relative to the privately insured and general medical populations. We need measures to alleviate the burden of being uninsured among young and otherwise healthy adults with IBD who are most vulnerable.

Original languageEnglish (US)
Pages (from-to)726-733
Number of pages8
JournalInflammatory Bowel Diseases
Volume15
Issue number5
DOIs
StatePublished - 2009

Fingerprint

Inflammatory Bowel Diseases
Hospitalization
Confidence Intervals
Odds Ratio
Inpatients
Censuses
Health Insurance
Insurance
Hispanic Americans
African Americans
Population
Comorbidity
Logistic Models
Incidence

Keywords

  • Crohn's disease
  • Health insurance
  • Hospitalization
  • Inflammatory bowel disease
  • Ulcerative colitis
  • Uninsured

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy

Cite this

Nguyen, G. C., Sam, J., Murthy, S. K., Kaplan, G. G., Tinmouth, J. M., & LaVeist, T. A. (2009). Hospitalizations for inflammatory bowel disease: Profile of the uninsured in the United States. Inflammatory Bowel Diseases, 15(5), 726-733. https://doi.org/10.1002/ibd.20825

Hospitalizations for inflammatory bowel disease : Profile of the uninsured in the United States. / Nguyen, Geoffrey C.; Sam, Justina; Murthy, Sanjay K.; Kaplan, Gilaad G.; Tinmouth, Jill M.; LaVeist, Thomas A.

In: Inflammatory Bowel Diseases, Vol. 15, No. 5, 2009, p. 726-733.

Research output: Contribution to journalArticle

Nguyen, GC, Sam, J, Murthy, SK, Kaplan, GG, Tinmouth, JM & LaVeist, TA 2009, 'Hospitalizations for inflammatory bowel disease: Profile of the uninsured in the United States', Inflammatory Bowel Diseases, vol. 15, no. 5, pp. 726-733. https://doi.org/10.1002/ibd.20825
Nguyen, Geoffrey C. ; Sam, Justina ; Murthy, Sanjay K. ; Kaplan, Gilaad G. ; Tinmouth, Jill M. ; LaVeist, Thomas A. / Hospitalizations for inflammatory bowel disease : Profile of the uninsured in the United States. In: Inflammatory Bowel Diseases. 2009 ; Vol. 15, No. 5. pp. 726-733.
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title = "Hospitalizations for inflammatory bowel disease: Profile of the uninsured in the United States",
abstract = "Background: Inflammatory bowel disease (IBD) patients may be at increased risk for having no health insurance. Our objectives were to assess the prevalence of hospitalized IBD patients without insurance in the US and to characterize predictive factors. Methods: We identified IBD admissions in the Nationwide Inpatient Sample (1999-2005) and a 1{\%} sample of general medical patients. We used population estimates from the US Census Bureau to calculate hospitalization rates, and logistic regression to determine predictors of being uninsured. Results: Although uninsured IBD patients were less likely to be hospitalized than those privately insured (incidence rate ratio [IRR] 0.41; 95{\%} confidence interval [CI]: 0.38-0.45), their hospitalization rate increased from 8.3/100,000 to 12.5/100,000 (P <0.001) over 7 years, outpacing private admissions. The proportion of uninsured IBD inpatients increased from 4.6{\%} to 6.5{\%} (P <0.001), and IBD patients were more likely than general medical patients to be uninsured (5.1{\%} vs. 4.1{\%}, P a 0.0001). Predictors of being uninsured were being 21 to 40 years (odds ratio [OR] 1.95; 95{\%} CI: 1.64-2.31), African American (OR 1.51; 95{\%} CI: 1.29-0.76) or Hispanic (OR 2.21; 95{\%} CI: 1.79 -2.74), or residing in the southern US (OR 1.63; 95{\%} CI: 1.27-2.11). Being female (OR 0.65; 95{\%} CI: 0.61-0.70), residing in higher income neighborhoods (OR 0.69; 95{\%} CI: 0.62- 0.77), and higher comorbidity were protective factors. Conclusions: The rate of uninsured IBD admissions has risen disproportionately relative to the privately insured and general medical populations. We need measures to alleviate the burden of being uninsured among young and otherwise healthy adults with IBD who are most vulnerable.",
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AU - Tinmouth, Jill M.

AU - LaVeist, Thomas A.

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