B40-03 Insurance Status And Access To Critical Respiratory Support In Acute Respiratory Failure: A Nationwide Analysis

Background

Timely escalation to life-sustaining respiratory support is central to the management of acute respiratory failure. Whether insurance status is associated with access to critical respiratory interventions and subsequent in-hospital mortality at a national level remains incompletely characterized.

Objective

To evaluate the association between insurance status, receipt of life-sustaining respiratory support, and in-hospital mortality among adults hospitalized with acute respiratory failure in the United States.

Methods

We conducted a retrospective cohort study using the Nationwide Inpatient Sample from 2018 to 2021. Adult hospitalizations with acute respiratory failure were identified using ICD-10-CM diagnosis codes. Insurance status was categorized according to the primary expected payer as private, public (Medicare/Medicaid), or uninsured. Life-sustaining respiratory support was identified using ICD-10-PCS procedure codes, including invasive mechanical ventilation and other critical respiratory interventions. Multivariable logistic regression models were used to examine associations between insurance status and outcomes, adjusting for patient demographics, comorbidities, hospital characteristics, admission year, and weekend admission. Discharge-level survey weights were applied to generate nationally representative estimates. Data analysis was performed using IBM SPSS Statistics 25.0.

Results

Among patients hospitalized with acute respiratory failure, uninsured individuals had significantly lower adjusted odds of receiving life-sustaining respiratory support compared with privately insured patients. Uninsured status was also independently associated with higher in-hospital mortality. These associations persisted after comprehensive adjustment for clinical, hospital-level, and temporal factors, including year of admission.

Conclusions

In this nationally representative analysis, uninsured status was independently associated with reduced access to life-sustaining respiratory support and increased in-hospital mortality among patients with acute respiratory failure. These findings raise concern for inequities in critical care escalation during acute respiratory decompensation and highlight the need for strategies to ensure equitable delivery of life-saving respiratory care.

This abstract is funded by: none