Uninsured Americans Carry Large Chronic Disease Burden
By John Gever
MedPage Today
Published: August 05, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
CAMBRIDGE, Mass., Aug. 5 — Nearly one-third of uninsured Americans under age 65 reported having cardiovascular disease, diabetes, hypertension, or some other chronic condition, researchers here said.
Action Points
- Explain that the study found that almost one-third of non-elderly adults without health insurance had at least one major chronic disease.
- Explain that the result refutes suggestions that the uninsured are largely healthy people who do not often need healthcare.
Data from the National Health and Nutrition Examination Survey (NHANES) showed that percentages of uninsured people reporting a chronic condition ranged from 11.9% for hypercholesterolemia (95% CI 9.3% to 12.6%) to 19.3% for asthma and COPD (95% CI 16% to 22.3%), reported Andrew P. Wilper, M.D., M.P.H., of Cambridge Health Alliance, and colleagues in the Aug. 5 issue of Annals of Internal Medicine.
Percentages for other chronic diseases were:
- Cardiovascular disease, 16.1% (95% CI 12.6% to 19.6%)
- Hypertension, 15.5% (95% CI 13.4% to 17.6%)
- Diabetes mellitus, 16.6% (95% CI 13.2% to 20%)
- Previous cancer (excluding non-melanoma skin cancer), 15.4% (95% CI 11.5% to 19.3%)
Some 31.3% of the uninsured had at least one of the six conditions (95% CI 28.7% to 34%), the researchers said.
“These findings counter notions that persons without insurance are a largely healthy population with little need for ongoing medical care,” Dr. Wilper and colleagues wrote.
The researchers said 45.4% of insured patients had at least one chronic disease. The higher percentage was likely because they were older on average than the uninsured, they said.
In June, the CDC reported that about 43 million Americans, 14.5% of the overall population, were uninsured in 2007. (See Southwest Lags in Health Insurance Coverage)
According to the NHANES data — from surveys conducted from 1999 through 2004 — 20.8% of the non-elderly adult population, or 36.4 million individuals (95% CI 33.1 to 40 million), were without health insurance.
The study was only the second to examine the burden of chronic disease in the uninsured, Dr. Wilper and colleagues said. The earlier research, covering 1997 and 1998 with a different data set, found substantially lower rates of chronic disease, suggesting a trend toward poorer health status among the uninsured.
The NHANES survey obtained data on health insurance status and other health-related information from 12,486 respondents.
Dr. Wilper and colleagues found that, after adjusting for age, sex, and race/ethnicity, lack of insurance significantly predicted a lower likelihood of seeing a health professional in the past year (6.2% versus 22.6% for the insured, P<0.001).
Those without insurance were also more likely to name an emergency department as their standard site of care (7.1% versus 1.1%, P<0.001) and to report not having a standard site of care (22.6% versus 6.2%, P<0.001).
“For some of the 11.4 million uninsured Americans with serious chronic conditions, access to care seems to be unobtainable; many may face early disability and death as a result,” Dr. Wilper and colleagues wrote.
They pointed out that treatments for the six chronic conditions are both standard and a national priority.
The researchers suggested that a healthcare system with a de facto exclusion based on insurance status is unethical.
In an accompanying editorial, Marshall H. Chin, M.D., M.P.H., of the University of Chicago, commented that ensuring good treatment for chronic disease will require more than health insurance reform.
“It will not be sufficient unless it is coupled with quality improvement efforts targeting the reasons that vulnerable populations with access to care often do not receive optimal care,” he wrote.
He noted that quality of care varies among facilities and regions. For example, he said, recent budget cuts have hit public clinic and hospital systems in Atlanta and Chicago.
“Healthcare reform must ensure that adequate resources flow to healthcare organizations and providers that serve a disproportionate share of vulnerable patients,” Dr. Chin said.
Programs to reduce disparities in care can improve outcomes for the uninsured immediately, even in the absence of insurance reform, he said.
The study was funded by the Health Resources and Services Administration. No potential conflicts of interest were reported.
Primary source: Annals of Internal Medicine
Source reference:
Wilper A, et al “A national study of chronic disease prevalence and access to care in uninsured U.S. adults” Ann Intern Med 2008; 149: 170-76.
Additional source: Annals of Internal Medicine
Source reference:
Chin M “Improving care and outcomes of uninsured persons with chronic disease … now” Ann Intern Med 2008; 149: 206-207.
http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/tb/10436