title: Lack of private health insurance is associated with higher mortality from cancer and other chronic diseases, poor diet quality, and inflammatory biomarkers in the United States.
abstract: OBJECTIVE
  The lack of health insurance reduces access to care and often results in poorer health outcomes. The present study simultaneously assessed the effects of health insurance on cancer and chronic disease mortality, as well as the inter-relationships with diet, obesity, smoking, and inflammatory biomarkers. We hypothesized that public/no insurance versus private insurance would result in increased cancer/chronic disease mortality due to the increased prevalence of inflammation-related lifestyle factors in the underinsured population.
  
  
  METHODS
  Data from the Third National Health and Nutrition Examination Survey participants (NHANES III;1988-1994) were prospectively examined to assess the effects of public/no insurance versus private insurance and inflammation-related lifestyle factors on mortality risk from cancer, all causes, cardiovascular disease (CVD) and diabetes. Cox proportional hazards regression was performed to assess these relationships.
  
  
  RESULTS
  Multivariate regression analyses revealed substantially greater risks of mortality ranging from 35% to 245% for public/no insurance versus private insurance for cancer (HR=1.35; 95% CI=1.09,1.66), all causes (HR=1.54; 95% CI=1.39,1.70), CVD (HR=1.62; 95% CI=1.38,1.90) and diabetes (HR=2.45; 95% CI=1.45,4.14). Elevated CRP, smoking, reduced diet quality and higher BMI were more prevalent in those with public insurance, and were also associated with increased risks of cancer/chronic disease mortality.
  
  
  CONCLUSIONS
  Insurance status was strongly associated with cancer/chronic disease mortality after adjusting for lifestyle factors. The results suggest that inadequate health insurance coverage results in a substantially greater need for preventive strategies that focus on tobacco control, obesity, and improved dietary quality. These efforts should be incorporated into comprehensive insurance coverage programs for all Americans.
authors.affiliation: The Ohio State University, College of Medicine, Division of Health Sciences and Medical Dietetics, Columbus, OH, United States; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States. Electronic address: bittoni.1@osu.edu.
authors.forename: Marisa A
authors.initials: MA
authors.lastname: Bittoni
authors.affiliation: The Ohio State University, College of Medicine, Department of Family Medicine, Columbus, OH, United States.
authors.forename: Randy
authors.initials: R
authors.lastname: Wexler
authors.affiliation: The Ohio State University, College of Medicine, Division of Health Sciences and Medical Dietetics, Columbus, OH, United States; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: Spees
authors.affiliation: The Ohio State University, College of Medicine, Division of Medical Oncology, Columbus, OH, United States; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Clinton
authors.affiliation: The Ohio State University, College of Medicine, Division of Health Sciences and Medical Dietetics, Columbus, OH, United States; The Ohio State University, College of Medicine, Department of Family Medicine, Columbus, OH, United States.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000401:mortality; D002908:Chronic Disease / Q000401:mortality*; D004032:Diet; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D009749:Nutrition Surveys; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D014481:United States
chemical_list: D015415:Biomarkers
keywords: Cancer mortality; Cardiovascular disease mortality and all cause mortality; Diabetes mortality; Health insurance; Inflammation; Lifestyle