Lack of Health Insurance Increases All Cause and All Cancer Mortality in Adults: An Analysis of National Health and Nutrition Examination Survey (NHANES III) Data


Background: Public use National Health and Nutrition Examination Survey (NHANES III) and NHANES IIIlinked mortality data were here applied to investigate the association between health insurance coverage and allcause and all cancer mortality in adults. Patients and
Methods: NHANES III household adult, laboratory andmortality data were merged. Only patients examined in the mobile examination center (MEC) were included inthis study. The sampling weight employed was WTPFEX6, SDPPSU6 being used for the probability samplingunit and SDPSTRA6 to designate the strata for the survey analysis. All cause and all cancer mortalities wereused as binary outcomes. The effect of health insurance coverage status on all cause and all cancer mortalitieswere analyzed with potential socioeconomic, behavioral and health status confounders.
Results: There were 2398sample persons included in this study. The mean age was 40 years and the mean (S.E.) follow up was 171.85 (3.12)person months from the MEC examination. For all cause mortality, the odds ratios (significant p-values) of thecovariates were: age, 1.0095 (0.000); no health insurance coverage (using subjects with health insurance), 1.71(0.092); black race (using non-Hispanic white subjects as the reference group) 1.43, (0.083); Mexican-Americans,0.60 (0.089); DMPPIR, 0.82, (0.000); and drinking hard liquor, 1.014 (0.007). For all cancer mortality, the oddsratio (significant p-values) of the covariates were: age, 1.0072 (0.00); no health insurance coverage, using withhealth coverage as the reference group, 2.91 (0.002); black race, using non-Hispanic whites as the referencegroup, 1.64 (0.047); Mexican Americans, 0.33 (0.008) and smoking, 1.017 (0.118).
Conclusion: There was a 70%increase in risk of all cause death and almost 300% of all cancer death for people without any health insurancecoverage.