How Does Insurance Affect the Risk of Premature Death Among the Near-elderly? A Lot for Whites, a Little for Blacks
For many Americans nearing retirement, not having health insurance can substantially increase their risk of a premature death. But for African Americans in their 50s and early 60s, having insurance provides only a slight increase in life expectancy, which is already lower than that of white Americans. These are some of the findings of a recent Brigham and Women's and HMS study of how insurance coverage correlates with mortality.Using the 1992 federal Health and Retirement Study, the researchers determined the insurance status of nearly 9,000 people aged 51 to 61. The team, led by HMS associate professor of medicine and of health care policy John Ayanian, identified those in this group who had died by 2000. Other members of the research team included HMS clinical fellow in medicine J. Michael McWilliams, HMS professor of health care policy (statistics) Alan Zaslavsky, and HMS assistant professor of health care policy Ellen Meara.
Overall, the statistical risk of death for uninsured individuals with low incomes, diabetes, hypertension, or heart disease was more than 50 percent higher than for their insured counterparts--even after adjustment for the higher risk of health problems in low-income, uninsured individuals. Among the white subjects, being uninsured resulted in a 57 percent greater chance of dying. But for African Americans in this age group, having insurance did not offer a clear survival advantage. Data pertaining to Hispanics was insufficient to draw definitive conclusions.
Previous research from Ayanian and others has shown that the uninsured are less likely to undergo routine checkups and more likely to have difficulty paying for treatments for chronic diseases or potentially serious symptoms. Broadening the availability of insurance--a campaign promise from both major parties' White House hopefuls this election year--will be a critical step toward reducing the tens of thousands of early deaths; however, "we still have to keep in mind that it's only part of the work ahead of us to make sure that everyone gets the health care they need," Ayanian said.
In the study, published in the July/August issue of Health Affairs, the researchers write that the findings may indicate that social factors beyond insurance coverage still play a big role in the health of African Americans. Factors such as inadequate communication, subconscious biases, or stereotyping by heath care providers may limit their access to effective care. Meanwhile, lifelong risk factors such as job discrimination and lower incomes may increase the chances of becoming ill. Such factors contribute to a shorter average life expectancy, according to the U.S. Department of Health and Human Services, of 72 years for African Americans compared with 78 years for whites.
--Stu Hutson