Lack of health insurance and decline in overall health in late middle age

Background: The number of adults in their 50s and 60s in the United States who do not have health insurance is increasing. This group may be particula rly vulnerable to the ill effects of being uninsured. Methods: We conducted a prospective cohort study using files from the Healt h and Retirement Study, a national survey of adults who were 51 to 61 years old in 1992. We determined the risks of a major decline in overall health and of the development of new physical difficulties between 1992 and 1996 f or participants who were continuously uninsured (uninsured in 1992 and in 1 994), those who were intermittently uninsured (uninsured either in 1992 or in 1994), and those who were continuously insured. We used logistic regress ion to determine the independent effects of being uninsured on health outco mes after adjustment for base-line sociodemographic factors, preexisting me dical conditions, and types of health-related behavior such as smoking and alcohol use. Results: We analyzed data for 7577 participants. The 717 continuously unins ured participants and the 825 intermittently uninsured participants were mo re likely than the 6035 continuously insured participants to have a major d ecline in overall health between 1992 and 1996 (21.6 percent, 16.1 percent, and 8.3 percent of the three groups, respectively; P<0.001 for both compar isons). According to a multivariate analysis, the adjusted relative risk of a major decline in overall health was 1.63 (95 percent confidence interval , 1.26 to 2.08) for continuously uninsured participants and 1.41 (95 percen t confidence interval, 1.11 to 1.78) for intermittently uninsured participa nts, as compared with continuously insured participants. A new difficulty i n walking or climbing stairs was also more likely to develop in the continu ously or intermittently uninsured participants than in the continuously ins ured participants (28.8 percent, 26.4 percent, and 17.1 percent of the thre e groups, respectively; P<0.001 for both comparisons). The adjusted relativ e risk of such a new physical difficulty was 1.23 (95 percent confidence in terval, 1.02 to 1.47) for the continuously uninsured participants and 1.26 (95 percent confidence interval, 1.01 to 1.54) for the intermittently unins ured participants. Conclusions: The lack of health insurance is associated with an increased r isk of a decline in overall health among adults 51 to 61 years old. (N Engl J Med 2001;345:1106-12.) Copyright (C) 2001 Massachusetts Medical Society.