title: Characteristics of uninsured Americans with chronic kidney disease.
abstract: BACKGROUND
  In the United States, public health insurance is available for nearly all persons with end-stage renal disease (ESRD). Little is known about the extent of health insurance coverage for persons with non-dialysis dependent chronic kidney disease (CKD).
  
  
  OBJECTIVE
  To describe patterns of health insurance coverage for adults with non-dialysis dependent CKD and to examine risk factors for progression of CKD to ESRD and management of hypertension among those lacking insurance.
  
  
  METHODS
  Cross-sectional analysis of data from a nationally representative sample of 16,148 US adults aged 20 years or older who participated in the National Health and Nutrition Examination Survey 1999-2006.
  
  
  METHODS
  National prevalence estimates of health insurance coverage, ESRD risk factors, and treatment of hypertension.
  
  
  RESULTS
  An estimated 10.0% (95% CI, 8.3%-12.0%) of US adults with non-dialysis dependent CKD were uninsured, 60.9% (95% CI, 58.2%-63.7%) had private insurance and 28.7% (95% CI, 26.4%-31.1%) had public insurance alone. Uninsured persons with non-dialysis dependent CKD were more likely to be under the age of 50 (62.8% vs. 23.0%, P < 0.001) and nonwhite (58.7%, vs. 21.8%, P < 0.001) compared with their insured counterparts. Approximately two-thirds of uninsured adults with non-dialysis dependent CKD had at least one modifiable risk factor for CKD progression, including 57% with hypertension, 40% who were obese, 22% with diabetes, and 13% with overt albuminuria. In adjusted analyses, uninsured persons with non-dialysis dependent CKD were less likely to be treated for their hypertension (OR, 0.59; 95% CI, 0.40-0.85) and less likely to be receiving recommended therapy with angiotensin inhibitors (OR, 0.45; 95% CI, 0.26-0.77) compared with those with insurance coverage.
  
  
  CONCLUSIONS
  Uninsured persons with non-dialysis dependent CKD are at higher risk for progression to ESRD than their insured counterparts but are less likely to receive recommended interventions to slow disease progression. Lack of public health insurance for patients with non-dialysis dependent CKD may result in missed opportunities to slow disease progression and thereby reduce the public burden of ESRD.
authors.affiliation: Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, 111M, Seattle, WA 98108, USA. ynhall@u.washington.edu
authors.forename: Yoshio N
authors.initials: YN
authors.lastname: Hall
authors.forename: Rudolph A
authors.initials: RA
authors.lastname: Rodriguez
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Ann M
authors.initials: AM
authors.lastname: O'Hare
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult