Impact of health insurance status on hospitalization and mortality from emergency department admission in patients with end-stage kidney disease: a Korean nationwide registry analysis

Background Health insurance plays a critical role in healthcare accessibility and outcomes, particularly for patients with end-stage kidney disease (ESKD). This retrospective observational study evaluated the relationships between health insurance status and rates of hospitalization and in-hospital mortality among patients with ESKD visiting the emergency department (ED). Methods We retrospectively analyzed data from the National Emergency Department Information System in South Korea from January 2018 to December 2021. Patients were identified on the basis of their ICD-10 codes (N18.5) and categorized by health insurance type (Medical Aid [MA] recipients vs. National Health Insurance [NHI] beneficiaries). The primary outcomes were rates of hospitalization and in-hospital mortality from ED admission. Multivariate logistic regression models were used to assess the associations between insurance type and outcomes. Results Among the 157,794 ED visits, 23.5% were by MA recipients and 76.5% by NHI beneficiaries. The participants in the MA group were younger than those in the NHI group, and the proportions of females and those with severe disease were lower in the MA group. After adjusting for age, sex, and the Korean Triage and Acuity Scale score, the MA group had a lower hospitalization risk but a risk of death similar to that of the NHI group. Patients <60 years of age had a lower hospitalization rate but a higher in-hospital mortality. Conclusion Young, economically active MA patients were less likely to be admitted but had poor clinical outcomes after admission, suggesting their reluctance toward hospitalization for economic reasons.