The trends in the uninsured rates among non-elderly adult patients hospitalized with acute pancreatitis in the US during 2004-2019.

Background and AimThe impact of health reforms such as affordable care act (ACA) and Medicaid expansion program on health insurance coverage among acute pancreatitis (AP) patients in the United States (US) is unknown. We report the trends and forecasts for the uninsured rates among acute pancreatitis (AP) patients in the US. MethodsWe included non-elderly adult patients (aged 18 -64 years), hospitalized with AP in the nationwide inpatient sample database years 2004-2019. We calculated the percentage of uninsured and Medicaid patients for each year and applied joinpoint (JP) regression model to study the trends. ResultsThe uninsured rates among patients hospitalized with AP were almost twice compared to the national average rates for all hospitalized patients. Uninsured rates were higher among Hispanic and African American races, rural location, lower income quartiles and in the southern US regions. A statistically significant decline was observed during 2013-2016 with an APC of - 12.23 (-20--4); p<0/01). The decline was apparent among all racial groups, locations and income groups but not in the southern region where gap in the uninsured rates worsened compared to other geographical regions. The trends reversed more recently, and the uninsured rates surged in 2018 for the first time after 2010. In 2019, 12.5% AP patients were uninsured compared to 11.6% in 2017. The forecasts after taking unemployment rates into account showed that uninsured rates would peak in 2020 followed by a gentle decline in the following years but overall uninsured rates would remain higher compared to 2017. ConclusionsThe ACA and Medicaid expansion programs resulted in overall decrease in the uninsured rates, particularly among racial minorities, rural location and in the lowest income group. However, there was a surge in uninsured rate in the most recent years (2017-2019) which will continue during the next four years