Other observational studies have found similar increased mortality rates among uninsured with specific diseases such as HIV. However, this is the first national study in more than a decade to look at all-cause mortality among the insured and uninsured.
According to lead author J. Michael McWilliams, MD, a medical resident at BWH and graduate of HMS, "These older uninsured Americans are particularly vulnerable because the consequences of uninsurance are more severe for those who are aging and in declining health. Our current system of public and private insurance options fails to provide affordable coverage to near-elderly adults with low incomes or chronic disease who are most likely to benefit from regular medical care. As a result, we estimate that more than 100,000 adults in this age group may die prematurely in the next eight years because they currently lack health insurance. This number is likely to grow rapidly as the Baby Boom generation ages and the near-elderly population swells. Earlier preventive care and treatment of chronic diseases may also limit the economic impact on the Medicare program as these previously uninsured adults may be healthier when the become eligible for Medicare."
In this study, McWilliams and colleagues including John Ayanian, MD of BWH and HMS followed 8,736 near-elderly adults in the Health and Retirement Study - 7,199 privately insured and 1,537 uninsured - from 1992 to 2000. Controlling for numerous differences between the groups, the authors compared mortality between insured and uninsured adults and assessed whether mortality differed by race and ethnicity, income and the presence or absence of diabetes, hypertension or heart disease. Researchers found that the uninsured were 43 percent more likely to die prematurely during the study period than their insured counterparts. Uninsured adults with low incomes were 53 percent more likely to die prematurely, and those with diabetes, hypertension or heart disease had a 56 percent greater risk of premature death. Mortality did not significantly differ between insured and uninsured black adults, suggesting that expanding coverage alone may not be sufficient to reduce the increased mortality experienced by near-elderly blacks.
Approximately 3.5 million people ages 55 to 64 years were uninsured in the United States in 2002. Based on estimates from this study, the number of deaths expected due to lack of coverage would place uninsurance third on a list of leading causes of death for this age group, after only heart disease and cancer. As the near-elderly population grows, the number of annual deaths due to uninsurance may exceed 30,000 by 2015. Reforms to expand coverage to this vulnerable group could therefore save thousands of lives.