Illness Often Undiscovered and Undertreated Among the Uninsured

WASHINGTON - A new study shows uninsured American adults with chronic illnesses
like diabetes or high cholesterol often go undiagnosed and
undertreated, leading to an increased risk of costly, disabling and
even lethal complications of their disease.

The study, published online today [Tuesday] in Health Affairs,
analyzed data from a recent national survey conducted by the Centers
for Disease Control and Prevention (CDC). The researchers, based at
Harvard Medical School and the affiliated Cambridge Health Alliance,
analyzed data on 15,976 U.S. non-elderly adults from the National Health and Nutrition Examination Survey (NHANES), a CDC program, between 1999 and 2006.

Respondents answered detailed questions about their health and
economic circumstances. Then doctors examined them and ordered
laboratory tests.

The study found that about half of all uninsured people with
diabetes (46 percent) or high cholesterol (52 percent) did not know
they had these diseases. In contrast, about one-quarter of those with
insurance were unaware of their illnesses (23 percent for diabetes,
29.9 percent for high cholesterol).

Undertreatment of disease followed similar patterns, with the
uninsured being more likely to be undertreated than their insured
counterparts: 58.3 percent vs. 51.4 percent had their high blood
pressure poorly controlled, and 77.5 percent vs. 60.4 percent had their
high cholesterol inadequately treated.

Surprisingly, being insured was not associated with a widely used
measure of diabetes control (a hemoglobin A1c level below 7), a finding
the authors attribute to the stringent definition of good diabetes
control used in the NHANES survey. Even with
excellent medical care, many diabetics fail to achieve such low
hemoglobin A1c levels. Using less stringent hemoglobin A1c thresholds
of 8 and 9, uninsured adults had significantly worse blood sugar
control than their insured counterparts, the researchers found.

Lead author Dr. Andrew Wilper, who worked at Harvard when the study
was done and who now teaches at the University of Washington Medical
School, said: “Our study should lay to rest the myth that the uninsured
can get the care they need. Millions have serious chronic conditions
and don’t even know it. And they’re not getting care that would prevent
strokes, heart attacks, amputations and kidney failure.”

Referring to a study released in the American Journal of Public
Health last month, which has been widely quoted by Sen. Max Baucus and
others, he added: “Our previous work demonstrated 45,000 deaths
annually are linked to lack of health insurance. Our new findings
suggest a mechanism for this increased risk of death among the
uninsured. They’re not getting life-saving care.”

Dr. Steffie Woolhandler, professor of medicine at Harvard and study
co-author, said: “The uninsured suffer the most, but even Americans
with insurance have shocking rates of undertreatment, in part because
high co-payments and deductibles often make care and medications
unaffordable. We need to upgrade coverage for the insured, as well as
covering the uninsured. Only single-payer national health insurance
would make care affordable for the tens of millions of Americans with
chronic illnesses.”

Dr. David Himmelstein, associate professor of medicine at Harvard
and study co-author, said: “The Senate Finance Committee’s bill would
leave 25 million Americans uninsured and unable to get the ongoing,
routine care that could save their lives and prevent disability. No
other wealthy nation tolerates this, yet Congress is turning its back
on tens of millions of Americans.”

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“Hypertension, diabetes and elevated cholesterol among insured and uninsured adults,” Andrew P. Wilper, M.D., M.P.H.; Steffie Woolhandler, M.D., M.P.H.; Karen Lasser, M.D., M.P.H.; Danny McCormick, M.D., M.P.H.; David H. Bor, M.D.; David U. Himmelstein, M.D. Health Affairs, Oct. 20, 2009 (online).

Physicians for a National Health Program (www.pnhp.org)
is a research and educational organization of 17,000 doctors who
support single-payer national health insurance. To speak with a
physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.