Study Rationale:Quantifying these disparities across Medicare, Medicaid, private insurance, and uninsured populations provides critical evidence to inform health policy and improve equitable access to life-saving care.

Title: Insurance Status and In-Hospital Outcomes Among Adults With Acute Leukemia: A Nationwide Analysis (2016–2021)

Authors & Affiliations: A. Parulkar¹, S. S. Saa¹, K. W. H. Hla¹, Y. M. Myat¹, M. Kalavar¹, L. Enayati¹, Y. N. Pinkhusovich¹, K. Panigrahi¹, and T. H. Oo²

1. One Brooklyn Health, Brooklyn, USA

2. The University of Texas MD Anderson Cancer Center, Houston, USA

Introduction

 

• High-Acuity Need: Acute myeloid leukemia and acute lymphoblastic leukemia require rapid, intensive, and high-cost inpatient interventions to prevent early mortality.

• Access Barrier: Health insurance coverage serves as the primary gateway to timely hematologic care, diagnostic testing, and specialized oncologic therapies.

• Knowledge Gap: While health disparities in oncology are documented, the specific impact of insurance status on inpatient survival and resource consumption (hospital charges and length of stay) remains understudied at a national scale.

• Study Rationale: Quantifying these disparities across Medicare, Medicaid, private insurance, and uninsured populations provides critical evidence to inform health policy and improve equitable access to life-saving care.

Aim

 

To evaluate the independent association between insurance status, in-hospital mortality, and healthcare resource utilization among older adults ($\ge 50$ years) hospitalized with acute leukemia using a nationally representative US cohort.

Methods

 

• Dataset: National Inpatient Sample (NIS), 2016–2021.

• Population: Adult patients ($\ge 50$ years) hospitalized with a primary diagnosis of AML or ALL ($N = 86,700$).

• Stratification: Medicare, Medicaid, Private Insurance, Uninsured (reference group).

• Statistical Analysis: Multivariable logistic and linear regression models adjusted for demographics, Charlson Comorbidity Index, and hospital characteristics.

Results

 

1. Patient Demographics & Insurance Distribution ($N = 86,700$)

 

• Medicare: 61.8%

• Private Insurance: 28.8%

• Medicaid: 7.7%

• Uninsured: 1.8%

• Setting: Most patients were treated at large, urban teaching hospitals.

2. Multivariable Adjusted Mortality Odds (vs. Uninsured Reference, aOR 1.0)

 

• Medicare: aOR 0.46 (95% CI: 0.33–0.65)

• Private Insurance: aOR 0.47 (95% CI: 0.33–0.65)

• Medicaid: aOR 0.50 (95% CI: 0.34–0.74)

• Key Takeaway: All insured groups had significantly lower odds of inpatient mortality compared to uninsured patients.

3. Total Hospital Charges & Length of Stay (LOS) (vs. Uninsured)

 

• Total Hospital Charges:

  • Medicare: +$39,656

  • Private: +$61,997

  • Key Takeaway: Medicare and private insurance incurred significantly higher total hospital charges.

• Length of Stay:

  • Private: +2.5 days ($p < 0.05$)

  • Medicare & Medicaid: No significant differences observed.

4. Predicted Inpatient Mortality Trends (2016–2021)

 

• Peak Disparity: Uninsured mortality peaked at 35% in 2016.

• Convergence: Insured groups (Medicare, Private, Medicaid) stabilized around ~10% mortality by 2021.

• Key Takeaway: Uninsured patients had disproportionately higher predicted mortality throughout the study period, leaving a persistent survival gap.

Conclusions

 

• Mortality Impact: Lack of insurance is a strong, independent predictor of in-hospital mortality in adult acute leukemia.

• Resource Disparity: Insured patients undergo more intensive diagnostic and therapeutic pathways, evidenced by significantly higher hospital charges and longer stays.

• Policy Implication: Structural policy interventions expanding coverage are urgently required to eliminate financial barriers to life-saving hematologic care.