Journal of General Internal Medicine

, Volume 22, Issue 4, pp 502–507

Risk of Cardiovascular Events and Death—Does Insurance Matter?

Authors

    • Division of General Medicine and EpidemiologyUniversity of North Carolina at Chapel Hill
    • Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel Hill
  • Giselle Corbie-Smith
    • Division of General Medicine and EpidemiologyUniversity of North Carolina at Chapel Hill
    • Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel Hill
    • Department of Social MedicineUniversity of North Carolina at Chapel Hill
  • Joanne Garrett
    • Center for Women’s Health ResearchUniversity of North Carolina at Chapel Hill
  • Nicole Lurie
    • RAND Corporation
Original Article

DOI: 10.1007/s11606-007-0127-2

Cite this article as:
Fowler-Brown, A., Corbie-Smith, G., Garrett, J. et al. J GEN INTERN MED (2007) 22: 502. doi:10.1007/s11606-007-0127-2

Abstract

BACKGROUND

Many Americans lack health insurance. Despite good evidence that lack of insurance compromises access to care, few prospective studies examine its relationship to health outcomes.

OBJECTIVE

To determine the relationship between insurance and cardiovascular outcomes and the relationship between insurance and selected process measures.

DESIGN AND PARTICIPANTS

We used data from 15,792 participants in the Atherosclerosis Risk in Communities Study, a prospective cohort study. Participants were enrolled in 1987–1989 and returned for follow-up visits every 3 years, for a total of 4 visits.

MAIN OUTCOME MEASURES

We estimated the hazard of myocardial infarction, stroke, and death associated with insurance status using Cox proportional hazard modeling. We used generalized estimating equations to examine the association between insurance status and risk of (1) reporting no routine physical examinations, (2) being unaware of a personal cardiovascular risk condition, and (3) inadequate control of cardiovascular risk conditions.

RESULTS

Persons without insurance had higher rates of stroke (adjusted hazard ratio, 95% CI 1.22–2.22) and death (adjusted hazard ratio 1.26, 95% CI 1.03–1.53), but not myocardial infarction, than those who were insured. The uninsured were less likely to report routine physical examinations (adjusted risk ratio 1.13, 95% CI 1.08–1.18); more likely to be unaware of hypertension (adjusted risk ratio 1.12, 95% CI 1.00–1.25) and hyperlipidemia (adjusted risk ratio 1.11, 95% CI 1.03–1.19); and more likely to have poor blood pressure control (adjusted risk ratio 1.23, 95% CI 1.08–1.39).

CONCLUSIONS

Lack of health insurance is associated with increased rates of stroke and death and with less awareness and control of cardiovascular risk conditions. Health insurance may improve cardiovascular risk factor awareness, control and outcomes.

KEY WORDS

insurancecerebrovascular diseasecardiovascular diseasepopulations at riskmortalityatherosclerosis

Copyright information

© Society of General Internal Medicine 2007