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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

At the time of this research, all authors were with the Department of Medicine at Cambridge Health Alliance, affiliated with Harvard Medical School, Cambridge, MA.

Correspondence: Correspondence should be sent to

Andrew P. Wilper, MD, MPH, Veterans Affairs Medical Center, 500 W Fort St, Boise, ID 83702 (e-mail: wilp9522@u.washington.edu). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link.

Objectives. A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data.

Methods. We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey. We analyzed participants aged 17 to 64 years to determine whether uninsurance at the time of interview predicted death.

Results. Among all participants, 3.1% (95% confidence interval [CI] = 2.5%, 3.7%) died. The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only, was 1.80 (95% CI = 1.44, 2.26). After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use, the uninsured were more likely to die (hazard ratio = 1.40; 95% CI = 1.06, 1.84) than those with insurance.

Conclusions. Uninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time.

December 2009, Vol 99, No. 12 | American Journal of Public Health 2289-2295
© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.157685 
RESEARCH AND PRACTICE

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