title: Health insurance coverage and the risk of decline in overall health and death among the near elderly, 1992-2002.
abstract: BACKGROUND
  Although individuals' health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time.
  
  
  OBJECTIVE
  We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death from 1992 to 2002, accounting for changes in self-reported overall health and insurance coverage.
  
  
  METHODS
  We analyzed data from the Health and Retirement study, a prospective cohort study of a national sample of community-dwelling adults age 51-61 years old at baseline. Major decline in self-reported overall health and mortality was determined at 2-year intervals.
  
  
  RESULTS
  People who were uninsured at baseline had a 35% (95% confidence interval [CI] 12-62%) higher risk-adjusted mortality from 1992 to 2002 compared with those with private insurance. However, when we analyzed outcomes over 2-year intervals, individuals who were uninsured at the start of each interval were more likely to have a major decline in their overall health (pooled adjusted relative risk 1.43, 95% CI 1.28-1.63), but they were equally likely to die (pooled adjusted relative risk 0.96, 95% CI 0.73-1.27). Of the 1512 people who were uninsured at baseline, 220 (14.6%) died; of those who died, only 70 (31.8%) were still uninsured at the HRS interview prior to death.
  
  
  CONCLUSIONS
  Death does not appear to be a short-term consequence of being uninsured. Instead, higher long-term mortality among the uninsured results from erosion in this population's health status over time and the attendant higher mortality associated with this. Most deaths among the uninsured occur after individuals have gained either public or private health insurance.
authors.affiliation: Department of Medicine and the Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. dwbaker@northwestern.edu
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Sudano
authors.forename: Ramon
authors.initials: R
authors.lastname: Durazo-Arvizu
authors.forename: Joseph
authors.initials: J
authors.lastname: Feinglass
authors.forename: Whitney P
authors.initials: WP
authors.lastname: Witt
authors.forename: Jason
authors.initials: J
authors.lastname: Thompson
mesh_terms: D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011446:Prospective Studies; D012650:Self Disclosure; D014481:United States