Health Care Costs and Financing

Late middle-aged adults are more likely to decline in overall health when they have no health insurance

About 16 percent of adults in late middle age (early 50s to early 60s) have no health insurance, and this number is increasing. This group may be particularly vulnerable to the ill effects of being uninsured, suggests a study supported by the Agency for Healthcare Research and Quality (HS10283).

The researchers found that 717 continuously uninsured people and 825 intermittently uninsured people were more likely than the 6,035 continuously insured late middle-aged adults to have a major decline in overall health between 1992 and 1996 (22 percent, 16 percent, and 8 percent, respectively). After adjusting for other factors besides insurance, continuously uninsured adults were nearly twice as likely to have a major decline in overall health as adults who continued to have insurance during that time. Intermittently uninsured adults were 1.41 times more likely to experience a major health decline.

People who either had no insurance or were only intermittently insured also were more likely to develop a new difficulty in walking or climbing stairs compared with continuously insured adults (29 percent, 26 percent, and 17 percent, respectively). After adjustment for baseline differences, the continuously uninsured adults were 23 percent more likely to develop a new physical difficulty that affected walking or climbing stairs.

These findings are consistent with recent studies reporting that uninsured individuals are less likely than others to have a primary care provider and more likely to delay seeking care or go without needed care. Renewed efforts at comprehensive reform of the U.S. system of health insurance may be needed to increase coverage among adults in late middle age, concludes David Baker, M.D., M.P.H., of Case Western Reserve University. The study findings are based on a prospective analysis of files from the Health and Retirement Study, a national survey of adults who were 51 to 61 years of age in 1992.

See "Lack of health insurance and decline in overall health in late middle age," by Dr. Baker, Joseph J. Sudano, Ph.D., Jeffrey M. Albert, Ph.D., and others, in the October 11, 2001 New England Journal of Medicine 345(15), pp. 1106-1112.

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