Research has consistently demonstrated the correlation between uninsured status and increased risks of death and unavailability of health insurance, such as through routine federal surveys containing coverage data and mortality figures, and this new state by state study by Families USA provides this evidence publicly for the first time.
Researchers found that working-age Americans without health insurance are at a 40 percent increased risk of death; this number is approximately two and a half times higher than estimates from the Institute of Medicine in 2002.
1. Deaths from Heart Disease
Heart disease and stroke are leading causes of death in the U.S. When someone passes from either condition, not only their life is taken from them – their loved ones must grieve as well as face financial repercussions such as medical bills and wages lost, not to mention disability and decline in physical activity levels.
Researchers from Harvard Medical School discovered that annually 45,000 Americans die because they lack health insurance and cannot access care; that number outpaces that of those killed due to drunk driving or murder combined.
This research, released Thursday in the American Journal of Public Health, replicated an IOM study from 2006 which estimated 18,000 adults die annually due to not having health insurance coverage. But this time around, using an alternative methodology believed more accurately reflects uninsured deaths, the researchers came up with much higher numbers.
Researchers examined mortality data from the National Center for Health Statistics, including age-adjusted rates of cardiovascular disease (CVD) deaths – such as coronary heart disease, stroke and other diseases of the arteries). Additionally, they used this same data to estimate how many more people might have survived if they had been insured – ultimately they discovered that people without health insurance were at 25 percent higher risk of dying from CVD than those covered – driven by factors like high cholesterol levels, blood pressure levels and smoking as these are controllable factors while factors like age or family history cannot be controlled for.
2. Deaths from Cancer
Cancer is one of the primary causes of death, alongside heart disease. Studies by the Institute of Medicine suggest that without health insurance coverage approximately 18,000 people die every year from cancer alone – this figure represents roughly equaling diabetes, stroke and homicide combined.
However, the Institute of Medicine estimates a figure 20 percent lower than what should be. This difference can be explained by their method for calculating it: their researchers broke census data down by age group before applying a suggested health research standard that suggests uninsurance increases one’s chances of dying by 25 percent – this resulted in lower than anticipated death numbers.
Families USA conducted an in-depth analysis using an advanced statistical method to calculate the number of deaths related to lack of health insurance. Their researchers studied mortality rates across counties in the U.S. and found that those that expanded Medicaid saw dramatic decreases in mortality; their results suggest that national expansion programs could potentially save thousands of lives each year.
Family USA study also provided state-level estimates of deaths related to lack of health insurance, using methods similar to those employed by the Institute of Medicine and Urban Institute to derive its figures. Its authors acknowledged, however, that their analyses relied upon survey data collected more than two decades ago, adding that medical treatments and demographics have changed considerably since.
3. Deaths from Stroke
An estimated 45,000 Americans die every year as a result of lack of health insurance, nearly twice the number estimated previously. A 2002 Institute of Medicine study determined that Americans without coverage had a 25 percent higher death risk compared to those covered. A new study published today in the American Journal of Public Health shows this difference to be even more marked.
Researchers used data from the Third National Health and Nutrition Examination Survey and other sources. They looked at a sample of working-age adults aged 17-64 from working-age households without health insurance as well as stroke patients with and without it to compare survival rates; and adjusted their findings according to age, gender, smoking status, education level level and family size variables.
Factoring in these and other variables, they found that uninsured stroke patients experienced a 26 percent higher mortality rate compared to those insured by health plans. Furthermore, uninsured stroke patients were less likely to receive appropriate care as well as incur hospital costs exceeding annual income after accounting for food costs.
Research has highlighted the consequences of uninsurance, yet few studies have focused on quantifying this gap at a county-level. Furthermore, most studies focus on differences in out-of-hospital deaths rather than hospital deaths; thus it’s critical that we understand which factors influence differences in mortality at a county level and to measure whether these variations reflect demographics, socioeconomic characteristics, health risk profiles or access to quality healthcare.
4. Deaths from Diabetes
Evidence indicates that health insurance reduces mortality. Two recent randomized controlled trials (RCTs), directly comparing individuals with and without health coverage, found that those without insurance died at significantly higher rates than their insured counterparts; furthermore, 1 longitudinal Health and Retirement Study analysis shows that increasing insurance coverage reduces mortality.
Urban Institute researchers recently published a new study which estimated that 45,000 deaths each year due to lack of health insurance were attributable to lack of coverage, according to data from a large national survey conducted by Medical Expenditure Panel Survey – double what was predicted by Institute of Medicine report published in 2002.
The study reviewed data from the Medical Expenditure Panel Survey (MEPS), established in 1996 and collected since then for purposes of measuring health care use, expenditures, sources of payment and coverage in U.S. civilian noninstitutionalized populations. For 2019, those 18-64 who reported diabetes were asked how long they had been uninsured – most uninsured individuals reported at least one year without coverage, many over multiple years.
Researchers found that uninsured adults with diabetes who experienced gaps in their coverage had a much higher death rate than those covered continuously by private health insurance, even after using sensitivity analyses that adjusted for demographic factors, smoking, alcohol consumption, body mass index, leisure-time activity levels due to illness limitations or restrictions, self-rated and physician-rated health, hospitalizations or doctor visits within the past year as well as previous hospitalizations/doctor visits within that same year. They determined uninsured individuals still faced a 25% higher risk than privately insured counterparts even after controlling for these factors and found uninsured individuals had an additional 25% risk.
5. Deaths from HIV/AIDS
At its height, AIDS posed such a grave threat that those without health insurance often died due to lack of treatment access, rather than from being exposed to HIV itself. Since then, however, progress in terms of access has been marked. With an improved vaccine available and effective medications becoming widely accessible due to efforts from international bodies and governments ensuring treatment availability has led to extraordinary preventive care services for people living with HIV.
Death remains a stark reality for those without access to treatment despite advances that allow HIV-infected individuals to live longer lives and achieve viral suppression – virtually eliminating transmission risk to partners. Yet one key factor remains an impediment to progress: lack of affordable health insurance plans.
Urban Institute, a research nonprofit group, recently released an updated estimate that being uninsured is a leading cause of death, expanding on previous estimates from six years ago from the Institute of Medicine that estimated such deaths at 18,000. Their new calculations used national survey data along with standard procedures from previous studies to determine that lack of coverage caused 44,789 additional deaths annually than indicated by IOM method estimates.
Researchers also note that this figure represents more than twice the annual homicide count and more than all of America’s annual mortality figures for diabetes, cancer, heart disease and other chronic illnesses combined.