American heart journal · 2026
Admission rates for pediatric supraventricular tachycardia are affected by primary insurance payor: An analysis of the NEDS database.
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Hakimi Mathew, Mondal Antara, Ampah Steve B, Tomlinson Alexis Z, O'Byrne Michael L, Janson Christopher
Аннотация
BACKGROUND: Recent data have highlighted potential disparities in the care of children with SVT. The impact of socioeconomic factors on emergency department (ED) outcomes for pediatric SVT has not been well characterized.
METHODS: We performed a retrospective cohort study utilizing the 2006 to 2018 US Nationwide Emergency Department Sample (NEDS). Encounters for patients age 0-18 years with a primary diagnosis of SVT were evaluated, excluding those with congenital heart disease. The primary exposure was insurance payor. The primary outcome was hospital admission/transfer. Secondary outcomes included inpatient length of stay (LOS), procedures, and mortality. Multivariable logistic regression models evaluated the association of payor with outcomes, including covariates of age, hospital teaching status, hospital region, patient residence, and patient income.
RESULTS: A total of 38,896 ED encounters were analyzed: median age 11.5 years (IQR 6-15); 48% male; 53% private payor, 38% public payor. Encounters with public payor had a higher rate of admit/transfer than private (24% vs 18%, P < .0001). There were no differences in LOS or procedures by payor. In multivariable analysis, public payor was an independent predictor of admission/transfer (OR 1.6, 95% CI 1.2-2.2). Patient age was also associated with admission/transfer, with all age groups less likely to undergo admission/transfer compared to age < 1 year.
CONCLUSIONS: Public insurance payor is associated with higher rates of hospital admission/transfer for pediatric SVT, independent of age. Further studies are needed to identify whether differential access to preventative care underlies this observation, as this may be a target for intervention.
METHODS: We performed a retrospective cohort study utilizing the 2006 to 2018 US Nationwide Emergency Department Sample (NEDS). Encounters for patients age 0-18 years with a primary diagnosis of SVT were evaluated, excluding those with congenital heart disease. The primary exposure was insurance payor. The primary outcome was hospital admission/transfer. Secondary outcomes included inpatient length of stay (LOS), procedures, and mortality. Multivariable logistic regression models evaluated the association of payor with outcomes, including covariates of age, hospital teaching status, hospital region, patient residence, and patient income.
RESULTS: A total of 38,896 ED encounters were analyzed: median age 11.5 years (IQR 6-15); 48% male; 53% private payor, 38% public payor. Encounters with public payor had a higher rate of admit/transfer than private (24% vs 18%, P < .0001). There were no differences in LOS or procedures by payor. In multivariable analysis, public payor was an independent predictor of admission/transfer (OR 1.6, 95% CI 1.2-2.2). Patient age was also associated with admission/transfer, with all age groups less likely to undergo admission/transfer compared to age < 1 year.
CONCLUSIONS: Public insurance payor is associated with higher rates of hospital admission/transfer for pediatric SVT, independent of age. Further studies are needed to identify whether differential access to preventative care underlies this observation, as this may be a target for intervention.