Health Insurance and Mortality in US Adults

Bibliographic Data

ID11029105
AuthorsAndrew P Wilper (At the time of this research, all authors were with the Department of Medicine at Cambridge Health Alliance, affiliated with Harvard Medical School, Cambridge, MA.), Steffie Woolhandler (0000-0002-8965-1058, At the time of this research, all authors were with the Department of Medicine at Cambridge Health Alliance, affiliated with Harvard Medical School, Cambridge, MA.), Karen E Lasser (0000-0003-3777-6075, At the time of this research, all authors were with the Department of Medicine at Cambridge Health Alliance, affiliated with Harvard Medical School, Cambridge, MA.), Danny Mccormick (At the time of this research, all authors were with the Department of Medicine at Cambridge Health Alliance, affiliated with Harvard Medical School, Cambridge, MA.), David H Bor (At the time of this research, all authors were with the Department of Medicine at Cambridge Health Alliance, affiliated with Harvard Medical School, Cambridge, MA.), David U Himmelstein (0000-0002-2394-4915, At the time of this research, all authors were with the Department of Medicine at Cambridge Health Alliance, affiliated with Harvard Medical School, Cambridge, MA.)
Year2009
Volume99
Issue12
Pages2289-2295
Publication date2009-12-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAmerican Journal of Public Health (JOURNAL)
Journal identifiersISSN: 0090-0036 • E-ISSN: 1541-0048
PublisherAmerican Public Health Association (PUBLISHER • US)
DOI10.2105/ajph.2008.157685
PMID19762659
PMCIDPMC2775760
OpenAlexW2142039787
LanguageEN
Citations received65
References cited25

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

Body mass index · Confidence interval · Environmental health · Ethnic group · Hazard ratio · Health care · Health insurance · National Death Index · National Health and Nutrition Examination Survey · National Health Interview Survey · Population · Demography · Food Security and Health in Diverse Populations · Healthcare Policy and Management · Healthcare Systems and Reforms · Internal Medicine · Medicine · Gerontology