A National Study of Chronic Disease Prevalence and Access to Care in Uninsured
Andrew P. Wilper, MD, MPH; Steffie Woolhandler, MD, MPH; Karen E. Lasser, MD, MPH; Danny McCormick, MD, MPH; David H. Bor, MD; and David U. Himmelstein, MD
August 2008 | Volume 149 Issue 3 | Pages 170-176
The Annals of Internal Medicine -
Available online at: http://www.annals.org/cgi/content/full/149/3/170
· Although many Americans lack health insurance, some policymakers claim that persons without insurance are largely healthy. However, the rates of chronic illness among those without insurance have not been well documented.
· By using data from the National Health and Nutrition Examination Survey (1999–2004), this study estimates that more than 11 million working-age Americans with cardiovascular disease, hypertension, diabetes, dyslipidemia, obstructive lung disease, or previous cancer do not have health insurance. Individuals without health insurance were more likely than those with insurance to report problems with access to health care.
· Many uninsured Americans have health conditions that require ongoing care.
Background: No recent national studies have assessed chronic illness prevalence or access to care among persons without insurance in the
Objective: To compare reports of chronic conditions and access to care among
Design: Population-based survey.
Setting: National Health and Nutritional Examination Survey (1999–2004).
Participants: 12 486 patients age 18 to 64 years.
Measurements: Estimates of national rates of cardiovascular disease, hypertension, diabetes, hypercholesterolemia, active asthma or chronic obstructive pulmonary disease, previous cancer, and measures of access to care.
Results: On the basis of National Health and Nutrition Examination Survey (1999–2004) responses, an estimated 11.4 million (95% CI, 9.8 million to 13.0 million) working-age Americans with chronic conditions were uninsured, including 16.1% (CI, 12.6% to 19.6%) of the 7.8 million with cardiovascular disease, 15.5% (CI, 13.4% to 17.6%) of the 38.2 million with hypertension, and 16.6% (CI, 13.2% to 20.0%) of the 8.5 million with diabetes. After the authors controlled for age, sex, and race or ethnicity, chronically ill patients without insurance were more likely than those with coverage to have not visited a health professional (22.6% vs. 6.2%) and to not have a standard site for care (26.1% vs. 6.2%) but more likely to identify their standard site for care as an emergency department (7.1% vs. 1.1%) (P <0.001 for all comparisons).
Limitation: The study was cross-sectional and used self-reported insurance and disease status.
Conclusion: Millions of
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