September 18, 2009 — In a new study, researchers estimate that 45,000 deaths per year in the U.S. are associated with not having health insurance.
That estimate appears in the advance online edition of the American Journal of Public Health.
Data came from about 9,000 people aged 17 to 64 who took part in a government health survey between 1988 and 1994. They were followed through 2000.
During those years, about 3% of the participants died. People without any health insurance were 40% more likely than people with health insurance to die during the years studied, regardless of factors such as age, gender, race, income, education, health status, BMI ( body mass index), exercise, smoking, and alcohol use.
The researchers then applied that finding to U.S. census data. "We calculated approximately 44,789 deaths among working-age Americans in 2005 associated with the lack of insurance," write the researchers, who included Andrew Wilper, MD, MPH.
Wilper worked on the study while at the Cambridge Health Alliance, which is associated with the Harvard Medical School. Wilper now works at the University of Washington.
Wilper's team can't rule out other factors that could have affected the results. But they note that people without health insurance often don't get preventive care or have a steady source for medical care, which could be risky.
SOURCES:
Wilper, A. American Journal of Public Health, Sept. 17, 2009; advance online edition
AJPH First Look, published online ahead of print Sep 17, 2009
AJPH First Look, published online ahead of print Sep 17, 2009
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American Journal of Public Health, 10.2105/AJPH.2008.157685
Research and Practice
Health Insurance and Mortality in US Adults
Andrew P. Wilper 1*, Steffie Woolhandler 2, Karen E. Lasser 2, Danny
McCormick 2, David H. Bor 2, David U. Himmelstein 2
1 University of Washington School of Medicine
2 Cambridge Health Alliance/Harvard Medical School
* To whom correspondence should be addressed. E-mail: wilp9522@u.washington.edu
.
Abstract
Objectives. A 1993 study found a 25% higher risk of death among uninsured
compared with privately insured adults. We analyzed the relationship between
uninsurance and death with more recent data.
Methods. We conducted a survival analysis with data
from the Third National Health and Nutrition Examination Survey. We analyzed
participants aged 17 to 64 years to determine whether uninsurance at the time of
interview predicted death.
Results. Among all participants, 3.1% (95% confidence
interval [CI]=2.5%, 3.7%) died. The hazard ratio for mortality among the
uninsured compared with the insured, with adjustment for age and gender only,
was 1.80 (95% CI=1.44, 2.26). After additional adjustment for race/ethnicity,
income, education, self- and physician-rated health status, body mass index,
leisure exercise, smoking, and regular alcohol use, the uninsured were more
likely to die (hazard ratio=1.40; 95% CI=1.06, 1.84) than those with insurance.
Conclusions. Uninsurance is associated with mortality.
The strength of that association appears similar to that from a study that
evaluated data from the mid-1980s, despite changes in medical therapeutics and
the demography of the uninsured since that time.
Key Words: Insurance, Health Financing, Access to Care,
Mortality, Surveys