As medical care has improved for people with health insurance, the consequences of being uninsured have worsened, according to a new study that says the lack of coverage translates into nearly 45,000 deaths each year among working-age Americans.
Researchers from Cambridge Health Alliance reported yesterday in the American Journal of Public Health on a study that followed 9,005 adults under 65 years old who took part in a national survey conducted by the Centers for Disease Control and Prevention from 1986 through 1994. After 12 years, 351 people had died. Sixty of them were uninsured, and 291 were insured.
After accounting for differences in age, education, income, and other factors, the researchers found that people without private insurance had a 40 percent higher risk of dying than people with private insurance.
An earlier study by the Institute of Medicine based on 16 years of data through 1993 found that uninsured people had a 25 percent higher risk of dying than insured people, which translated into 18,000 additional deaths.
"Being uninsured is more lethal relative to being insured than it was 20 years ago,'' coauthor Dr. Steffie Woolhandler said in an interview.
According to US Census figures released earlier this month, the number of uninsured people rose from 45.7 million in 2007 to 46.3 million in 2008.
Woolhandler, who advocates a single-payer form of universal health coverage, blamed three factors for the widening gap between those with and without insurance. More people are uninsured and the safety net for those people has eroded, she said. But the gap has also grown because the care that insured people are more likely to get has gotten better.
Treatments for chronic illnesses have improved, including blood pressure medications to control hypertension and statins to lower cholesterol, the authors write.
"We're much more vigilant about care of high cholesterol, diabetes, and hypertension, which has lowered the death rate of people with insurance, which is great, but the uninsured have not shared in those benefits,'' Woolhandler said.
"Uninsured people who have a chronic condition are less likely to know they have it, and even when they know they have it, they are less likely to be able to control it because control of chronic conditions involves regular visits to a primary care doctor.''
Dr. John Z. Ayanian, a professor of medicine and health policy at Harvard Medical School and Brigham and Women's Hospital, served on the committee that issued the 2002 Institute of Medicine report. He said the newer work confirms the results of several prior studies.
It also fits with his own research analyzing what happens when uninsured people turn 65 and qualify for Medicare. In that study, published in 2007, people with diabetes or cardiovascular disease were especially likely to see dramatic improvements in their health after gaining insurance coverage through the national plan for the elderly.
"This study underscores the serious health consequences that people face when they are uninsured, as well as the potential benefit of extending coverage to all Americans so that they have access to good primary and specialty care when they need it,'' Ayanian said.