title: Unhealthy and uninsured: exploring racial differences in health and health insurance coverage using a life table approach.
abstract: Millions of people in the United States do not have health insurance, and wide racial and ethnic disparities exist in coverage. Current research provides a limited description of this problem, focusing on the number or proportion of individuals without insurance at a single time point or for a short period. Moreover, the literature provides no sense of the joint risk of being uninsured and in need of medical care. In this article, we use a life table approach to calculate health- and insurance-specific life expectancies for whites and blacks, thereby providing estimates of the duration of exposure to different insurance and health states over a typical lifetime. We find that, on average, Americans can expect to spend well over a decade without health insurance during a typical lifetime and that 40% of these years are spent in less-healthy categories. Findings also reveal a significant racial gap: despite their shorter overall life expectancy, blacks have a longer uninsured life expectancy than whites, and this racial gap consists entirely of less-healthy years. Racial disparities in insurance coverage are thus likely more severe than indicated by previous research.
authors.affiliation: The Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Rockville, MD, USA. jkirby@ahrq.gov
authors.forename: James B
authors.initials: JB
authors.lastname: Kirby
authors.forename: Toshiko
authors.initials: T
authors.lastname: Kaneda
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015993:Life Tables; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology* / Q000706:statistics & numerical data; D008875:Middle Aged; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult