"Uninsured individuals are less likely to have a regular source of care, to use preventive services, to obtain timely care for acute medical problems, and to take medications for chronic illnesses," according to background information in the article. As a result, uninsured patients have higher rates of illness and death. Because of their higher prevalence of chronic disease, uninsured individuals in late middle age may be especially vulnerable to the adverse consequences of being uninsured.
David W. Baker, M.D., M.P.H., from Northwestern University, Feinberg School of Medicine, Chicago, and Joseph J. Sudano, Ph.D., of Case Western Reserve University, Cleveland, analyzed data from the Health and Retirement Study (HRS) in order to assess the number of patients whose health is at risk from being uninsured. Study participants aged 51 to 57 years (n = 6,065) were interviewed every two years from 1992 to 2000. At the time of interview, insurance coverage was determined and classified as private, public, or uninsured.
Researchers found that at least 23.3 percent of participants were uninsured at least once during the eight-year study period. The percentage of uninsured individuals decreased throughout the study at the time of interviews in 1992, 1994, 1996, 1998, and 2000, with 14.3 percent, 10.8 percent, 9.7 percent, 8.8 percent, and 8.2 percent of people uninsured, respectively. Often, people shifted between having insurance and being uninsured. About 60 percent of patients were continuously enrolled in private insurance through all five interviews. Women, African American and Hispanic individuals, and those with low family incomes and/or low educational attainment in 1992 were more likely to be uninsured at least once. Older age, male sex, poor overall health, having one or more chronic illness, and being uninsured at the start of the study were all associated with higher risk of death.
"The proportion of U.S. adults in late middle age at risk from being uninsured over a ten-year follow-up period was two to three times higher than cross-sectional estimates. At least one-quarter of older adults will be uninsured at some point during the years preceding eligibility for Medicare," the authors write. "There is now substantial evidence that uninsured adults in their preretirement years are at greatly increased risk for adverse health outcomes, and urgent policy measures are needed to expand coverage for this group."
(Arch Intern Med. 2005; 165: 770 – 776. Available post-embargo at www.archinternmed.com.)
Editor's Note: Supported by a grant from the Agency for Healthcare Research and Quality, Rockville, Md.
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Journal
Archives of Internal Medicine