The authors note that three factors may conspire to keep uninsured people from receiving timely detection and repair of abdominal aortic aneurysms. First, they may delay regular physical exams -- which can sometimes lead to an early detection of a pulsatile abdominal mass -- or which may include a routine abdominal X-ray or ultrasound, on which an AAA can sometimes be detected.
Second, even if their primary care or emergency room physician suspects a problem, uninsured people may not be able to get a referral to a surgeon who can repair an aneurysm electively. Third, hospitals and the health care system may present other barriers to diagnosis and surgery.
Because of all these factors, uninsured people are known to use the emergency department as their health care provider of last resort, in many cases only after severe symptoms arise. AAA is a condition that can persist for years without symptoms, then cause intense pain and other signs upon rupture. Because uninsured people with intact AAAs are less likely to get the regular primary medical care that could lead to a diagnosis, they may only find out they have the condition when they visit an emergency department because of symptoms.
But by then, their odds are worse. In the new study, AAA rupture patients of any insurance status who were admitted to the hospital for surgery from the emergency department had more than twice the death risk than those who were admitted for surgery non-emergently.
The uninsured may even be having an effect on the overall statistics for AAA, Upchurch offers. Despite major advances in diagnostic tools and surgical techniques over the past two deca
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
23-Sep-2003