Uninsured Children in the United States: An Investigation of lnpatient Mortality
Public Deposited- Last Modified
- February 25, 2020
- Creator
-
VanScoyoc, Erin
- Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
- Abstract
- Objective: We examined whether uninsured children in the United States have an increased risk of inpatient mortality compared to children with private or Medicaid insurance. Methods: The entire sample of pediatric discharges <=18 years excluding neonates from the National Inpatient Sample (NIS) database from 1997 to 2001 was used for this study. We calculated the inpatient mortality rate by dividing the weighted number of deaths over the five years of the study by the total weighted encounters, and used the Student t test to statistically compare the inpatient mortality rate of uninsured children to children with private or Medicaid insurance. We also examined the inpatient mortality rate of children with two catastrophic diseases of childhood, congenital heart disease and cancer, and tested whether uninsured children with these conditions have an increased risk of inpatient mortality. Results: Uninsured children have a significantly higher inpatient mortality rate than children with either Medicaid or private insurance. The all-cause inpatient mortality rate for uninsured children was 0.61, compared with an inpatient mortality rate of 0.39 for children with Medicaid insurance, and 0.36 for children with private insurance. This disparity in inpatient mortality rate was also observed in children with catastrophic diseases of childhood. Among children with congenital heart disease as the primary ICD-9 diagnosis at discharge, uninsured children had an inpatient mortality rate of 3.23, compared to an inpatient mortality rate of 2.65 in children with Medicaid insurance, and 2.02 among children with private insurance. Among children with malignant neoplasm as any ICD-9 diagnosis at discharge, uninsured children had an inpatient mortality rate of 1.69 compared to an inpatient mortality rate of 1.2 in children with private insurance. Children with Medicaid insurance had an inpatient mortality rate of 1.77. Conclusions: Despite the progress made by the Medicaid expansion and the SCRIP program towards insuring children in the late 1990s, more than one in ten children in the United States remain uninsured. These children have an increased risk of inpatient mortality compared to children with private or Medicaid insurance. Whether the increased mortality rate among uninsured children is due to lower access to care, a less safe environment, or poorer inpatient care, in light of our results it is important to continue the progress we have made toward insuring all children in the United States.
- Date of publication
- May 2004
- DOI
- Resource type
- Rights statement
- In Copyright
- Note
- Track: HC&P
- Paper type: Research or research design
- Advisor
- Konrad, Thomas
- Reviewer
- Harris, Russell
- Degree
- Master of Public Health
- Degree granting institution
- University of North Carolina at Chapel Hill
- Graduation year
- 2004
- Language
- Deposit record
- 564d1737-ca9b-4211-9c3e-c1926665c3df
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