title: Health insurance and mortality in US adults.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA. wilp9522@u.washington.edu
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Wilper
authors.forename: Steffie
authors.initials: S
authors.lastname: Woolhandler
authors.forename: Karen E
authors.initials: KE
authors.lastname: Lasser
authors.forename: Danny
authors.initials: D
authors.lastname: McCormick
authors.forename: David H
authors.initials: DH
authors.lastname: Bor
authors.forename: David U
authors.initials: DU
authors.lastname: Himmelstein
mesh_terms: D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality; D009749:Nutrition Surveys; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult