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Lack of Insurance Tied to Early Death

Near-elderly without it 43% likelier to succumb prematurely

WEDNESDAY, July 7, 2004 (HealthDayNews) -- Americans who lack health insurance when approaching retirement age are 43 percent more likely to die prematurely than their peers who have insurance.

That translates into 105,000 potentially preventable deaths in the next eight years, or about 13,000 annually, among people aged 55 to 64 who lack health insurance, said the authors of an article appearing in the July issue of Health Affairs. The study is the first in more than a decade to look at this particular topic.

"We were surprised by the sheer number of deaths," said study author Dr. J. Michael McWilliams, a medical resident at Brigham and Women's Hospital in Boston. "That would place uninsurance third on the list of causes of death after heart disease and cancer for this age group, although obviously that's double-counting."

About 3.5 million people aged 55 to 64 were uninsured in the United States in 2002. This age group is expected to double to about 62 million within the next 10 years. Assuming the same rate of uninsured people, that means the number of potentially preventable deaths may rise to more than 30,000 a year.

"That is more than the number of adults in this age group currently dying from diabetes, stroke and lung disease combined," McWilliams said.

The new research surfaces as presidential candidates prepare to address the issue of health-care coverage. "Both candidates have plans, but both have major challenges," McWilliams said.

The near-elderly age group is a particularly vulnerable one as health problems start to increase during this period, before these people are eligible for Medicare. "The consequences of being uninsured are more severe," McWilliams said.

Some experts feel an opportunity is being missed.

"This is the age group that is probably the most important age group from a health standpoint," said Dr. Michael L. Freedman, a professor of geriatric medicine and internal medicine at New York University School of Medicine. "This is the kind of group you do all your screening in, where your highest yield and the biggest cure rate comes up. The study has shown that this could affect a lot of the health of the country. These are the people that everyone should be going after."

The researchers followed 8,736 near-elderly adults, 7,199 of whom had private insurance and 1,537 of whom were uninsured in 1992. The study lasted eight years, until 2000.

Uninsured participants were 43 percent more likely to die early during the study period than those who were insured. Uninsured adults with low incomes were 53 percent more likely to die prematurely, while those with diabetes, hypertension or heart disease were 56 percent more likely to die before their time.

Death rates did not differ significantly between insured and uninsured black adults, indicating that health insurance alone may not be enough to reduce premature deaths.

Although the association is not a definitive, cause-and-effect one, it certainly raises a red flag. "It's hard to prove, but certainly there's a strong association between being uninsured and poorer health outcomes. And this study targets a population where that association may be particularly strong, and where reform may be particularly beneficial," McWilliams said.

Expanding coverage to this segment of the population could save thousands of lives, McWilliams added.

The authors point out, however, that all of the major policy options put forth have limitations. A Medicare buy-in would require premium subsidies. The tax credits proposed by President Bush are unlikely to be large enough, although those proposed by the presumptive Democratic presidential nominee, John Kerry, are more generous, they said.

Taking care of chronic diseases early and engaging in preventive medicine will also limit the burden on Medicare as this population becomes eligible for that program, McWilliams added.

More information

AARP has more on insurance before being eligible for Medicare.

SOURCES: J. Michael McWilliams, M.D., medical resident, Brigham and Women's Hospital, Boston; Michael L. Freedman, M.D., professor, geriatric medicine and internal medicine, New York University School of Medicine, New York City; July 2004 Health Affairs
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