Acute myocardial infarction (AMI) and stroke are unanticipated major healthcare events that require emergent and expensive care. Given the potential financial implications of AMI and stroke among uninsured patients, we sought to evaluate rates of catastrophic healthcare expenditures (CHEs), defined as expenses beyond financial means, in a period before the implementation of insurance expansion and protections in the Affordable Care Act.1 In a large, nationally representative database of inpatient hospitalizations, the National Inpatient Sample, we identified all AMI ( Clinical Classification Software code 100 as the primary diagnosis) and stroke ( International Classification of Diseases, Ninth Revision codes 430, 431, 432.x, 433.x1, 434.x1, or 436 as the primary diagnosis) hospitalizations among uninsured nonelderly adults (age,18–64 years) between 2008 and 2012. To estimate patient expenses relative to income, we obtained 2 data components from the National Inpatient Sample: hospitalization charges and an ordinal variable (value of 1–4) representing quartiles of median income based on residential ZIP code. However, patient incomes can vary widely for each income quartile, and assessing CHEs requires an estimate of patient-level income. Therefore, using a previously suggested microsimulation model for assessing patient-level income from community income quartiles, …

中文翻译：

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在美国，没有保险的急性心肌梗死和中风的灾难性健康支出负担

急性心肌梗塞（AMI）和中风是不可预料的重大医疗事件，需要紧急且昂贵的护理。鉴于未保险患者中AMI和中风的潜在财务影响，我们试图评估在《平价医疗法案》实施保险扩展和保护之前的一段时期内的灾难性医疗支出（CHE）的比率，定义为超出经济能力的支出。 1在一个大型的全国住院患者住院数据库（国家住院样本）中，我们确定了所有AMI（临床分类软件代码100为主要诊断）和中风（国际疾病分类，第9修订版代码430、431、432.x） 433.x1、434.x1或436.作为未保险的非老年人（年龄，在2008年至2012年之间）。为估算患者相对于收入的支出，我们从“全国住院患者样本”中获得了2个数据部分：住院费用和一个序数变量（值1-4），代表居住在中间收入的四分位数邮政编码。但是，每个收入四分位数的患者收入差异很大，评估CHE需要评估患者水平的收入。因此，使用先前建议的微观模拟模型来评估社区收入四分位数的患者水平收入，… 每个收入四分位数的患者收入可能相差很大，评估CHE需要评估患者水平的收入。因此，使用先前建议的微观模拟模型来评估社区收入四分位数的患者水平收入，… 每个收入四分位数的患者收入差异很大，评估CHE需要评估患者水平的收入。因此，使用先前建议的微观模拟模型来评估社区收入四分位数的患者水平收入，…