Abstract TP275: Impact of Insurance Status on Risk of Stroke Recurrence with Incident Cryptogenic Stroke: A secondary analysis of the CASPR study
Authors: Penckofer Mary , Goldstein Eric , Kathleen Murphy , Smith Matthew , Bowman Anna , Nahab Fadi , Daniel Jean-Philippe , Stretz Christoph , Peter Shani , Gaudio Elizabeth , Thacker Quentin , Nelson Ashley , Sathya Anvitha , Kam Wayneho , Kang Jieun , Ro Jennifer , Thompson Sean , Glover Patrick , Sehgal Siddharth , Xi Romi , Sarkar Monica , Melkumova Emiliya , Abburi Nandini , Rothstein Aaron , Thon Jesse , Thottempudi Neeharika , Aboul-Nour Hassan , Eklund Kelsey , Farooqui Mudassir , Rozental Stefano , Dumitrascu Oana , Sharrief Anjail , Kerrigan Deborah , Almallouhi Eyad , Al Kasab Sami , Peshwe Krithika , Luan Cindy , Doolittle Charles , Lineback Christina , Leung Lester , Kala Narendra , Linares Guillermo , Khezri Nicole , Nedelcu Simona , Yaghi Shadi , Salehi Omran Setareh , Siegler James 
Published: January 2025

Background:
It is known that there are discrepancies between insurance status and access to care for a variety of health conditions. In addition, differences have been shown in initial in-hospital management of stroke as well as outcomes in the acute setting. We sought to examine the relationship between insurance status and risk of recurrent stroke, major bleeding or death following an incident cryptogenic stroke.

Methods:
Patients with cryptogenic stroke included in a multicenter (n=27 sites) retrospective observational cohort and complete insurance status were evaluated for a primary composite outcome of recurrent stroke, major bleeding, or death. Insurance providers were categorized by Private/Veterans Administration, Medicare, Other, and Medicaid/pending/None, with the primary carrier ranked in that order when multiple insurance carriers applied. Descriptive statistics and an adjusted Cox proportional hazards regression were used to associate the primary insurance provider with the composite outcome, and with each unique secondary outcome, adjusting for age, stroke severity, pre-stroke disability, atherosclerotic risk factors, and potential embolic sources (e.g., patent foramen ovale).

Results:
Of the 2201 patients, 2006 (91.1%) had reported insurance information and were followed for a median of 1.50 years (interquartile range [IQR 0.41 - 2.99y]). The majority of patients were primary Medicare beneficiaries (42.3%), followed by private insurance (36.7%), Medicaid/none (18.1%) and Other (2.9%). Although there were important differences in demographic and neurodiagnostic results across insurance groups, compared to Private/VA beneficiaries, beneficiaries for Medicaid/pending/none had a higher rate of the composite outcome in adjusted regression (adjusted hazard ratio [HR] 1.35, 95% confidence interval [CI], 1.07-1.69) which was driven largely by the higher rate of recurrent stroke (adjusted HR 1.33, 95%CI, 1.02-1.73) with no significant difference in rate of major bleeding or death (p>0.05 for both).

Conclusions:
Independent of age, race, pre-existing disability, and atherosclerotic risk factors, insurance status was independently predictive of recurrent stroke in this diverse cohort of cryptogenic stroke.