Mortality in the Uninsured Compared With That in Persons With Public and Private Health Insurance

doi:10.1001/archinte.1994.00420210037005

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Vol. 154 No. 21, 14 November 1994

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Mortality in the Uninsured Compared With That in Persons With Public and Private Health Insurance

Paul D. Sorlie, PhD; Norman J. Johnson, PhD; Eric Backlund, MS; Douglas D. Bradham, DrPH

Arch Intern Med. 1994;154(21):2409-2416.

Abstract

Objective
To compare mortality in persons with employer-provided healthinsurance, Medicare, Medicaid, military health benefits, otherprivate health insurance, and no health insurance, before andafter adjustment for income and employment status.

Design
Cohort study using national survey data containing informationon social, economic, and demographic factors and health insurance,with deaths identified through matching to the National DeathIndex resulting in a mortality follow-up period of 5 years.

Setting
Noninstitutionalized population of the United States.

Participants
Approximately 150 000 respondents to national surveys conductedby the US Bureau of the Census (Current Population Surveys),aged 25 to 64 years.

Results
After adjustment for age and income, persons with Medicare andMedicaid had the highest mortality in comparison with thosewith employer-provided insurance, with relative risks generallygreater than 2. With adjustment for age and income, personswithout insurance had higher mortality than those with employer-providedinsurance, with relative risks of 1.2 for white men and 1.5for white women. These relationships held after adjustment foremployment status, with the working uninsured showing mortalitybetween 1.2 and 1.3 times higher than that of the working insured.Mortality was higher in those with lower incomes after adjustmentfor insurance status. Those with annual income of $10 000 orless per year had mortality about two times that of personswith incomes greater than $25 000 per year.

Conclusion
Mortality was lowest in employed persons with employer-providedhealth insurance. The higher mortality in those with publicinsurance or with no insurance reflects an indeterminate mixof selection on existing health status and access to medicalcare.

(Arch Intern Med. 1994;154:2409-2416)

Author Affiliations

From the Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Dr Sorlie); Bureau of the Census, Suitland, Md (Dr Johnson and Mr Backlund); and Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC (Dr Bradham).

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