Health: Health Insurance and Mortality in US Adults

Health Insurance and Mortality in US Adults

Beginning of Executive Summary:


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. (Am J Public Health. 2009;99:jjj–jjj. doi:10.2105/
AJPH.2008.157685