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. 2009 Dec;99(12):2289-95.
doi: 10.2105/AJPH.2008.157685. Epub 2009 Sep 17.

Health insurance and mortality in US adults

Andrew P Wilper  1 , Steffie Woolhandler, Karen E Lasser, Danny McCormick, David H Bor, David U Himmelstein
Affiliations

Health insurance and mortality in US adults

Andrew P Wilper et al. Am J Public Health. 2009 Dec.

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.

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Figures

FIGURE 1
FIGURE 1
Study population and exclusions. Note. NHANES III = National Health and Nutrition Examination Survey; VA/CHAMPUS = Veterans Affairs/Civilian Health and Medical Program of the Uniformed Services.
See this image and copyright information in PMC

References

    1. US Census Bureau Income, poverty, and health insurance coverage in the United States: 2007. Available at: http://www.census.gov/prod/2008pubs/p60-235.pdf. Accessed August 29, 2008
    1. Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the United States. JAMA 2000;284:2061–2069 - PubMed
    1. Ayanian JZ, Zaslavsky AM, Weissman JS, Schneider EC, Ginsburg JA. Undiagnosed hypertension and hypercholesterolemia among uninsured and insured adults in the Third National Health and Nutrition Examination Survey. Am J Public Health 2003;93:2051–2054 - PMC - PubMed
    1. Institute of Medicine Care Without Coverage, Too Little, Too Late. Washington, DC: The National Academies Press; 2002
    1. Franks P, Clancy CM, Gold MR. Health insurance and mortality. Evidence from a national cohort. JAMA 1993;270:737–741 - PubMed

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