Matthew Blattner1, James Price2, Matthew D Holtkamp3. 1. Walter Reed National Military Medical Center, Department of Neurology, United States. Electronic address: matthew.r.blattner.mil@mail.mil. 2. Walter Reed National Military Medical Center, Department of Neurology, United States. Electronic address: james.c.price137.mil@mail.mil. 3. Carl R. Darnall Army Medical Center, Department of Medicine, United States. Electronic address: Matthew.d.holtkamp.mil@mail.mil.
Abstract
OBJECTIVE: Do socioeconomic disparities exist in the US military healthcare system with ischemic stroke admissions? METHODS: Civilian healthcare in the United States is paid for by a variety of payers. Significant disparities exist in this system based upon socioeconomic status (SES). In contrast, the military healthcare system (MHS) is a universal healthcare system. Military rank is a SES surrogate. Data was collected from the MHS database for years 2010 through 2015. All admissions to military health care facilities with a primary diagnosis of ischemic stroke were reviewed. Military rank was compared for primary outcomes of: Disposition (In-hospital mortality and discharge destination setting) and IV tPA administration and for secondary outcomes of: Total cost of hospitalization and Length of hospital stay (LoS). All adjusted for relevant demographics and co-morbidities. RESULTS: Military rank was identified with 1895 (52.3%) of the 3623 admissions. The ranks identified were: Junior Enlisted 100 (2.7%), Senior Enlisted/Warrant Officers 1390 (38.4%), Junior Officers 59 (1.6%) and Senior Officers 346 (9.6%). Statistically significant results included: Lower SES group/ranks were more likely to have poor discharge destination setting while the highest SES group/ranks and had lower rates of in-hospital mortality, shorter lengths of stay and higher hospitalization costs after controlling for relevant variables. CONCLUSION: Higher military ranks (Higher SES) had shorter hospitalization stays, higher costs and less in-hospital mortality in the military's universal healthcare system. This suggests aggregate characteristics of SES plays a large role in the outcomes among SES groups. Published by Elsevier B.V.
OBJECTIVE: Do socioeconomic disparities exist in the US military healthcare system with ischemic stroke admissions? METHODS: Civilian healthcare in the United States is paid for by a variety of payers. Significant disparities exist in this system based upon socioeconomic status (SES). In contrast, the military healthcare system (MHS) is a universal healthcare system. Military rank is a SES surrogate. Data was collected from the MHS database for years 2010 through 2015. All admissions to military health care facilities with a primary diagnosis of ischemic stroke were reviewed. Military rank was compared for primary outcomes of: Disposition (In-hospital mortality and discharge destination setting) and IV tPA administration and for secondary outcomes of: Total cost of hospitalization and Length of hospital stay (LoS). All adjusted for relevant demographics and co-morbidities. RESULTS: Military rank was identified with 1895 (52.3%) of the 3623 admissions. The ranks identified were: Junior Enlisted 100 (2.7%), Senior Enlisted/Warrant Officers 1390 (38.4%), Junior Officers 59 (1.6%) and Senior Officers 346 (9.6%). Statistically significant results included: Lower SES group/ranks were more likely to have poor discharge destination setting while the highest SES group/ranks and had lower rates of in-hospital mortality, shorter lengths of stay and higher hospitalization costs after controlling for relevant variables. CONCLUSION: Higher military ranks (Higher SES) had shorter hospitalization stays, higher costs and less in-hospital mortality in the military's universal healthcare system. This suggests aggregate characteristics of SES plays a large role in the outcomes among SES groups. Published by Elsevier B.V.
Authors: Sofia Altuna-Venegas; Raul Aliaga-Vega; Jorge L Maguiña; Jose F Parodi; Fernando M Runzer-Colmenares Journal: Arch Gerontol Geriatr Date: 2019-01-29 Impact factor: 3.250
Authors: Jose A Betancourt; Paula Stigler Granados; Gerardo J Pacheco; Julie Reagan; Ramalingam Shanmugam; Joseph B Topinka; Bradley M Beauvais; Zo H Ramamonjiarivelo; Lawrence V Fulton Journal: Healthcare (Basel) Date: 2021-05-18