Health Insurance and Mortality in US Adults
Andrew P. Wilper, MD, MPH, Steffie Woolhandler, MD, MPH, Karen E. Lasser, MD, MPH, Danny McCormick, MD, MPH, David H. Bor, MD, and David U. Himmelstein, MD
The United States stands alone among industrialized nations in not providing health cov- erage to all of its citizens. Currently, 46 million Americans lack health coverage. Despite re-peated attempts to expand health insurance, uninsurance remains commonplace among US adults.
Health insurance facilitates access to health care services and helps protect against the high costs of catastrophic illness. Relative to the uninsured, insured Ameri- cans are more likely to obtain recommended screening and care for chronic conditions and are less likely to suffer undiagnosed chronic conditions3 or to receive substandard medical care.
Numerous investigators have found an as- sociation between uninsurance and death. The Institute of Medicine (IOM) estimated that 18314 Americans aged between 25 and 64 years die annually because of lack of health insurance, comparable to deaths because of diabetes, stroke, or homicide in 2001 among persons aged 25 to 64 years.
The IOM estimate was largely based on a single study by Franks et al. However, these data are now more than 20 years old; both medical therapeutics and the demography of the uninsured have changed in the interim.
We analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III). NHANES III collected data on a representative sample of Americans, with vital status follow-up through 2000. Our objective was to evaluate the relationship between uninsurance and death.
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