title: The impact of race, income, drug abuse and dependence on health insurance coverage among US adults.
abstract: Little is known about the impact of drug abuse/dependence on health insurance coverage, especially by race groups and income levels. In this study, we examine the disparities in health insurance predictors and investigate the impact of drug use (alcohol abuse/dependence, nicotine dependence, and illicit drug abuse/dependence) on lack of insurance across different race and income groups. To perform the analysis, we used insurance data (8057 uninsured and 28,590 insured individual adults) from the National Surveys on Drug Use and Health (NSDUH 2011). To analyze the likelihood of being uninsured we performed weighted binomial logistic regression analyses. The results show that the overall prevalence of lacking insurance was 19.6 %. However, race differences in lack of insurance exist, especially for Hispanics who observe the highest probability of being uninsured (38.5 %). Furthermore, we observe that the lowest income level bracket (annual income <$20,000) is associated with the highest likelihood of being uninsured (37.3 %). As the result of this investigation, we observed the following relationship between drug use and lack of insurance: alcohol abuse/dependence and nicotine dependence tend to increase the risk of lack of insurance for African Americans and whites, respectively; illicit drug use increases such risk for whites; alcohol abuse/dependence increases the likelihood of lack of insurance for the group with incomes $20,000-$49,999, whereas nicotine dependence is associated with higher probability of lack of insurance for most income groups. These findings provide some useful insights for policy makers in making decisions regarding unmet health insurance coverage.
authors.affiliation: College of Arts and Sciences, Emory University, Atlanta, GA, 30322, USA.
authors.forename: Nianyang
authors.initials: N
authors.lastname: Wang
authors.affiliation: Department of Economics and Finance, College of Business and Technology, East Tennessee State University, 227 Sam Wilson Hall, PO Box 70686, Johnson City, TN, 37614, USA. xiex01@etsu.edu.
authors.forename: Xin
authors.initials: X
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014029:Tobacco Use Disorder / Q000453:epidemiology; D055815:Young Adult
keywords: Drug abuse; Drug dependence; Health insurance coverage; Income; Prevalence; Race