Background The number of adults in their 50s and 60s in theUnited States who do not have health insurance is increasing.This group may be particularly vulnerable to the ill effectsof being uninsured.
Methods We conducted a prospective cohort study using filesfrom the Health and Retirement Study, a national survey of adultswho were 51 to 61 years old in 1992. We determined the risksof a major decline in overall health and of the developmentof new physical difficulties between 1992 and 1996 for participantswho were continuously uninsured (uninsured in 1992 and in 1994),those who were intermittently uninsured (uninsured either in1992 or in 1994), and those who were continuously insured. Weused logistic regression to determine the independent effectsof being uninsured on health outcomes after adjustment for base-linesociodemographic factors, preexisting medical conditions, andtypes of health-related behavior such as smoking and alcoholuse.
Results We analyzed data for 7577 participants. The 717 continuouslyuninsured participants and the 825 intermittently uninsuredparticipants were more likely than the 6035 continuously insuredparticipants to have a major decline in overall health between1992 and 1996 (21.6 percent, 16.1 percent, and 8.3 percent ofthe three groups, respectively; P<0.001 for both comparisons).According to a multivariate analysis, the adjusted relativerisk of a major decline in overall health was 1.63 (95 percentconfidence interval, 1.26 to 2.08) for continuously uninsuredparticipants and 1.41 (95 percent confidence interval, 1.11to 1.78) for intermittently uninsured participants, as comparedwith continuously insured participants. A new difficulty inwalking or climbing stairs was also more likely to develop inthe continuously or intermittently uninsured participants thanin the continuously insured participants (28.8 percent, 26.4percent, and 17.1 percent of the three groups, respectively;P<0.001 for both comparisons). The adjusted relative riskof such a new physical difficulty was 1.23 (95 percent confidenceinterval, 1.02 to 1.47) for the continuously uninsured participantsand 1.26 (95 percent confidence interval, 1.01 to 1.54) forthe intermittently uninsured participants.
Conclusions The lack of health insurance is associated withan increased risk of a decline in overall health among adults51 to 61 years old.
Source Information
From the Center for Health Care Research and Policy, MetroHealth Medical Center (D.W.B., J.J.S.), the Department of Epidemiology and Biostatistics, School of Medicine (D.W.B., J.M.A., E.A.B.), and the Department of Economics (A.D.), Case Western Reserve University, Cleveland.
Address reprint requests to Dr. Baker at the MetroHealth Medical Center, 2500 MetroHealth Dr., Rammelkamp 221, Cleveland, OH 44109-1998, or at dwb{at}po.cwru.edu.
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