Wilper, Andrew P., Woolhandler, Steffie, Lasser, Karen E., McCormick, Danny, Bor, David H., Himmelstein, David U. Health Insurance and Mortality in US Adults. Am J Public Health December 2009; 99(12). AJPH First Look, published online ahead of print Sep 17, 2009. [Abstract (html)][Full Text (pdf)]
The Institute of Medicine earlier calculated 18, 314 excess deaths among uninsured adults age 25-64 in 2000. Using the same method, this study estimates there were 35,327 excess deaths among uninsured adults 18-64 in 2005. An alternative calculation using the global hazard ratio for uninsured adults rather than age-specific hazard ratios, shows the number of excess deaths may be as high as 44, 789.
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.