ABSENCE OF HEALTH-INSURANCE IS ASSOCIATED WITH DECREASED LIFE EXPECTANCY IN PATIENTS WITH CYSTIC-FIBROSIS

Life expectancy for individuals with cystic fibrosis (CF) has increase d dramatically in the last 30 yr, but it is unclear whether the improv ed survival has applied equally to individuals with different health i nsurance status. We developed a retrospective inception cohort of all 189 patients with CF born 1/1/55 to 12/31/70 who had at least one hosp italization at a university referral center. The median survival for p atients with CF who were without health insurance was 6.1 yr compared with 20.5 yr for those with Medicaid and 20.5 yr for those with privat e insurance. Using multivariate Cox regression, health insurance and i ncreased socioeconomic status were independently associated with longe r survival. The adjusted relative risk of death was greater for the ab sence of health insurance than for factors previously shown to predict mortality in individuals with CF (female sex and presentation with me conium ileus). In summary, the absence of health insurance was associa ted with increased mortality rate in children with CF and was a strong er predictor of mortality than variables previously shown to be associ ated with mortality for CF. If increasing numbers of children with CF lose health insurance coverage, our results suggest that their life ex pectancy will decrease dramatically.