Inpatients With Sarcoidosis on Medicaid and Medicare Have Worse Outcomes

Inpatients with sarcoidosis on Medicare or Medicaid face significantly increased odds of adverse outcomes vs patients with private insurance, according to study findings presented at the American Thoracic Society (ATS) 2023 International Conference, held in Washington, DC, May 19 to 24.

Investigators sought to examine the effect of various types of insurance coverage on outcomes of sarcoidosis, a multisystemic granulomatous disease of unknown origin.

The analysis used ICD-9 codes to identify more than 222,000 cases with a primary diagnosis of sarcoidosis from the 2003 to 2014 National Inpatient Sample. The researchers defined prolonged length-of-stay (LOS) and higher total charges by values greater than the 90^th percentile. Chi-square analysis and 1-way ANOVA were used to compare complications, hospital characteristics, and demographics among patients with private insurance, Medicare, and Medicaid. Logistic regression was used to analyze the independent effect of insurance type on the outcomes of patients with sarcoidosis.

Investigators found almost 42% of patients used private insurance, a third used Medicaid, and not quite 16% had Medicare. There was a higher percentage of patients in the lowest income quartile with Medicaid (51%) and Medicare (37%), compared with patients insured privately (24%). Just over 50% of patients insured with Medicare were at least 65 years of age. Almost 70% of patients insured with Medicaid were Black.

Investigators noted a lower percentage of patients (1.2%) with private insurance had incidence of acute respiratory distress syndrome (ARDS) and incidence of the need for mechanical ventilation compared with patients with Medicaid (2.1%) or patients with Medicare (2.0%). The rate of ARDS was lower among patients with private insurance (1.7%) compared with patients with Medicaid (3.4%) or Medicare (2.8%). Compared with patients with private insurance, patients with Medicare had increased odds of prolonged LOS (odds ratio, 1.467; 95% CI, 1.338-1.609).

“Patients with Medicare and Medicaid had significantly increased odds of adverse outcomes following inpatient sarcoidosis management compared to privately insured patients,” investigators concluded. “Additional studies exploring the impact of the social determinants of health and disease in patients hospitalized with sarcoidosis are warranted,” the investigators added.