Disparities in Morbidity After Spinal Cord Injury Across Insurance Types in the United States

Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2022 · DOI: https://doi.org/10.1016/j.mayocpiqo.2022.04.004 · Published: June 1, 2022

Spinal Cord Injury Healthcare Public Health

Simple Explanation

This study investigates differences in the health of adults with traumatic spinal cord injuries (TSCIs) based on their insurance type: private versus governmental (Medicare). It looks at how common certain psychological, heart-related, and musculoskeletal conditions are in these groups. The study found that individuals with TSCIs on Medicare had higher rates of psychological, cardiometabolic, and musculoskeletal issues compared to those with private insurance. This suggests that insurance type may play a role in health outcomes after a spinal cord injury. These findings highlight potential disparities in healthcare access and quality for individuals with TSCIs based on their insurance coverage. Understanding these differences is crucial for improving care and reducing health disparities.

Study Duration

2007-2018

Participants

9081 privately insured and 7645 Medicare beneficiaries with traumatic spinal cord injuries (TSCIs)

Evidence Level

Not specified

Key Findings

1
Adults with TSCIs on Medicare had a significantly higher prevalence of psychological, cardiometabolic, and musculoskeletal morbidities compared to privately insured adults with TSCIs.
2
The 4-year incidences of most psychological, cardiometabolic, and musculoskeletal morbidities were considerably higher among adults with TSCIs on Medicare.
3
Adjusted survival models found that adults with TSCIs on Medicare had a greater hazard for developing psychological and cardiometabolic morbidities compared with privately insured adults with TSCI.

Research Summary

This study compared the prevalence and incidence of comorbidities among adults with traumatic spinal cord injuries (TSCIs) across insurance types (private vs governmental insurance) in the United States. The study found that adults with TSCIs on Medicare had a significantly higher prevalence and risk for developing common physical and mental health comorbidities, compared with privately insured adults with TSCIs. The findings highlight the need for clinical screening algorithms and policy interventions to reduce health care disparities associated with insurance types, particularly among racial/ethnic minorities with TSCIs.

Practical Implications

Clinical Screening

Inform clinical screening algorithms for mental and physical health risk factors in higher-risk populations with TSCIs.

Policy and Care Coordination

Design policies and care coordination strategies that emphasize reducing health care disparities associated with insurance types.

Equitable Access to Healthcare

Promote equitable access to healthcare and improved outcomes for individuals with TSCIs regardless of race/ethnicity and insurance types.

Study Limitations

1
The International Classiﬁcation of Diseases, Ninth Revision codes for the diagnosis of TSCI do not differentiate between a complete and incomplete spinal cord injury.
2
Private health insurance is typically offered through employment, through employment of a spouse, or if they are a dependent. The beneﬁciaries of commercial payor insurance can be traced back to both higher income level and possibility more family support in the home setting.
3
a limitation of this database is the lack of information regarding time since injury for this population with TSCI.

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