The number of adults in their 50s and 60s in the United States who do
not have health insurance is increasing. This group may be particularly
vulnerable to the ill effects of being uninsured.
We conducted a prospective cohort study using files from the Health and
Retirement Study, a national survey of adults who were 51 to 61 years
old in 1992. We determined the risks of a major decline in overall health
and of the development of new physical difficulties between 1992 and 1996
for participants who were continuously uninsured (uninsured in 1992 and
in 1994), those who were intermittently uninsured (uninsured either in
1992 or in 1994), and those who were continuously insured. We used logistic
regression to determine the independent effects of being uninsured on
health outcomes after adjustment for base-line sociodemographic factors,
preexisting medical conditions, and types of health-related behavior such
as smoking and alcohol use.
We analyzed data for 7577 participants. The 717 continuously uninsured
participants and the 825 intermittently uninsured participants were more
likely than the 6035 continuously insured participants to have a major
decline in overall health between 1992 and 1996 (21.6 percent, 16.1 percent,
and 8.3 percent of the three groups, respectively; P<0.001 for both
comparisons). According to a multivariate analysis, the adjusted relative
risk of a major decline in overall health was 1.63 (95 percent confidence
interval, 1.26 to 2.08) for continuously uninsured participants and 1.41
(95 percent confidence interval, 1.11 to 1.78) for intermittently uninsured
participants, as compared with continuously insured participants. A new
difficulty in walking or climbing stairs was also more likely to develop
in the continuously or intermittently uninsured participants than in the
continuously insured participants (28.8 percent, 26.4 percent, and 17.1
percent of the three groups, respectively; P<0.001 for both comparisons).
The adjusted relative risk of such a new physical difficulty was 1.23
(95 percent confidence interval, 1.02 to 1.47) for the continuously uninsured
participants and 1.26 (95 percent confidence interval, 1.01 to 1.54) for
the intermittently uninsured participants.
The lack of health insurance is associated with an increased risk of a
decline in overall health among adults 51 to 61 years old.
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.
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For those who are disabled
and forced to stop working long before middle age, the situation is not
only made worse, but those who might be helped to return to some form
of gainful employment had been able to pay for (or have benefits for)
the medical care and medications required don't, and so can't.