Education,income, occupational status and health risk behaviour

Aim Socio-economic status is associated with a variety of health-related behaviours. In our study, we determined the independent effects of income, educational attainment and occupational status on overweight, smoking and physical activity in the German population. Subjects and methods The German National Health Interview and Examination Survey is a representative sample of the German adult population and includes 7,124 men and women. Prevalences of obesity, smoking and physical inactivity stratified for education, income and occupational status were calculated. Multiple logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for education, income, occupational status and health-related behaviour, adjusted for age and gender. Results Health risk behaviours were more prevalent in subjects with lower education, income or occupational status. After mutual adjustment, education, income and occupation were independently associated with physical inactivity. Low education was strongly associated with both obesity (OR: 2.58, 95% CI: 1.99–3.34) and smoking (OR: 2.09, 95% CI: 1.71–2.54). Low income was associated with smoking (OR: 1.40, 95% CI: 1.07–1.83), but not with obesity, and low occupational status was associated with obesity (OR: 1.42, 95% CI: 1.05–1.92), but not with smoking. High income or occupation could not compensate for the impact of low education on obesity and smoking. Conclusion Low socio-economic status is associated with health risk behaviours. Concerning obesity and smoking, education was more important than income or occupational status. Public health programmes to reduce these risk factors should focus on early-life health education.     

California Medicaid enrollment and melanoma stage at diagnosis: a population-based study

BACKGROUND: Insurance status and SES are associated with the stage of melanoma at diagnosis. However, the influence of Medicaid enrollment on melanoma stage has not been studied in detail. This study examined the effect of Medicaid enrollment status and duration on melanoma stage at diagnosis in a large, multi-ethnic California population. METHODS: California Cancer Registry records were linked with statewide Medicaid enrollment files to identify 4558 men and women diagnosed with invasive cutaneous and metastatic melanoma during 1998-1999. Multivariate logistic regression was used to evaluate the association between prediagnosis Medicaid enrollment status and late-stage diagnosis and tumor depth at diagnosis. RESULTS: Late-stage disease was diagnosed in 27% of Medicaid and 9% of non-Medicaid melanoma patients. Those enrolled in Medicaid at diagnosis and those enrolled intermittently during the year prior to diagnosis had significantly greater covariate-adjusted odds of late-stage cancer than those not enrolled in Medicaid (OR 13.64, 95% CI=4.43, 41.98, and OR 2.77, 95% CI=1.28, 5.99, respectively). Participants continuously enrolled during the previous year were not at increased odds for late-stage disease. An increased likelihood of late-stage melanoma was also associated with low SES (p<0.05) and non-Hispanic black race/ethnicity (p<0.10) after covariate adjustment. CONCLUSIONS: Men and women intermittently enrolled in Medicaid or not enrolled until the month of diagnosis had a significantly increased likelihood of late-stage melanoma. Greater education and outreach, particularly in low-SES areas, are needed to improve melanoma awareness and access to screening.     

The influence of marital status on the use of breast,cervical, and colorectal cancer screening

PurposeTo examine the impact of marital status on the use of screening for breast, cervical, and colorectal cancer.MethodsWe relied on 2012 Behavioral Risk Factor Surveillance System Survey age-appropriate screening cohorts. Appropriate screening for breast, cervical, and colorectal cancer was determined according to United States Preventive Services Task Force recommendations in effect at the time of the 2012 survey. Complex samples logistic regression models were performed to examine the effect of marital status on cancer screening.ResultsOverall, 81.6, 83.9, and 68.9% of married participants underwent breast, cervical, and colorectal cancer, respectively, relative to 74.2, 75.1, and 60.9% for divorced/widowed/separated, individuals, and 74.7, 78.7, and 53.4% for never married individuals. Marital status (married vs. never married) was an independent predictor of screening for all cancers examined: breast cancer, odds ratio (OR): 1.42 (95% confidence interval [CI]: 1.25–1.61); cervical cancer, OR: 1.29 (95% CI: 1.16–1.43); colorectal cancer, OR: 1.63 (95% CI: 1.51–1.77). Gender-specific subgroup analyses for colorectal cancer suggests that marital status may exert a greater effect in men, relative to women (married men: OR 1.75, 95% CI: 1.56–1.96; married women: OR: 1.52, 95% CI: 1.35–1.70).ConclusionBeing married is associated with increased utilization of breast, cervical, and colorectal cancer screening. The influence of marital status was greater in men relative to women eligible for colorectal cancer screening. Our results emphasize the importance of social determinants of health-seeking behaviors.     

Non-small Cell Lung Cancer Treatment Receipt and Survival Among African-Americans and Whites in a Rural Area

Data on racial disparities among lung cancer patients in rural areas are scarce. We examined differences in treatment receipt and survival among African-American (AA) and Non-Hispanic White (NHW) non-small cell lung cancer (NSCLC) patients residing in Southwest Georgia (SWGA)—a primarily rural 33-county area; population 700,000. Medical records for 934 SWGA NSCLC patients diagnosed in 2001–2003 were used to extract information on age, race, marital status, insurance coverage, comorbidities, and treatment. Information pertaining to socioeconomic status, urban/rural residence, and survival was obtained from the cancer registry. Multivariable logistic regression analyses examined the relation of various patient and disease characteristics to receipt of tumor-directed therapy. Cox regression models were used to assess determinants of survival. Treatment receipt was associated with age, marital status, comorbidities, and disease stage in most analyses. No associations were observed between race and either surgery [odds ratio (OR) 0.83, 95 % confidence interval (CI) 0.49–1.39] or radiation (OR 0.72; 95 % CI 0.52–1.00). NHW patients were more likely to receive no treatment at all (OR 1.50, 95 % CI 1.01–2.23). There was no racial difference in survival (hazard ratio = 1.07, 95 % CI 0.90–1.26). Effects of insurance and treatment on survival were most pronounced within 6 months post-diagnosis, but were attenuated over time. We found no evidence of racial disparities in survival and, in some analyses, a decreased likelihood of treatment receipt among NHW NSCLC patients compared to AA. The results from SWGA stand in contrast to studies that applied different methodologies and were conducted elsewhere.     

The effects of physician supply on the early detection of colorectal cancer

BACKGROUND: Policymakers question whether there is a relationship between the number and distribution of physicians and the outcomes for important health conditions. We hypothesized that increasing primary care physician supply would be related to earlier detection of colorectal cancer. METHODS: We identified incident cases of colorectal cancer occurring in Florida in 1994 (n = 8,933) from the state cancer registry. We then obtained measures of physician supply from the 1994 American Medical Association Physician Masterfile and examined the effects of physician supply (at the levels of county and ZIP code clusters) on the odds of late-stage diagnosis using multiple logistic regression. RESULTS: For each 10-percentile increase in primary care physician supply at the county level, the odds of late-stage diagnosis decreased by 5% (adjusted odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.92 - 0.99; P = .007). For each 10-percentile increase in specialty physician supply, the odds of late-stage diagnosis increased by 5% (adjusted OR = 1.05; 95% CI, 1.02-1.09; P = .006). Within ZIP code clusters, each 10-percentile increase in the supply of general internists was associated with a 3% decrease in the odds of late-stage diagnosis (OR = 0.97; 95% CI, 0.95 - 0.99; P = .006), and among women, each 10-percentile increase in the supply of obstetrician/gynecologists was associated with a 5% increase in the odds of late-stage diagnosis (OR = 1.05; 95% CI, 1.01 - 1.08; P = .005). CONCLUSIONS: If the relationships observed were causal, then as many as 874 of the 5463 (16%) late-stage colorectal cancer diagnoses are attributable to the physician specialty supply found in Florida. These findings suggest that an appropriate balance of primary care and specialty physicians may be important in achieving optimal health outcomes.     

Socio-demographic factors, health behavior and late-stage diagnosis of breast cancer in Germany: a population-based study.

Late-stage diagnosis of breast cancer is associated with poor survival. Identification of individuals at high risk of late-stage diagnosis could be an effective step to reduce breast cancer mortality. We examined the association of socio-demographic factors and health behavior with breast cancer stage in a population-based sample of 380 female breast cancer patients in Saarland, Germany. Overall, 182 women (47.9%) were diagnosed with late-stage (regional or distant) breast cancer. After control for potential confounding by multivariate logistic regression, an increased risk of late-stage diagnosis was observed for older age (OR = 1.8; 95% CI 1.0-3.2), foreign nationality (OR = 3.9; 95% CI 0.7-20.8), living in large households (OR = 1.7; 95% CI 1.0-2.9), non-participation in general health check-up (OR = 1.5; 95% CI 0.9-2.4) and low interest in health care (OR = 1.6; 95% CI 1.0-2.7). The proportion of late-stage cancer was clearly decreased when tumors were detected by screening (OR = 0.4; 95% CI 0.2-0.8). Certain socio-demographic factors and characteristics of health behavior seem to represent independent risk indicators of late-stage diagnosis.     

Demographic predictors of melanoma stage at diagnosis

OBJECTIVE: To examine sociodemographic characteristics as possible predictors of late-stage melanoma diagnosis. We hypothesized that late-stage diagnosis would be associated with the following: older age, male sex, unmarried status, lower educational attainment and income level, rural residence, and cigarette smoking. METHODS: We used data from the state tumor registry to study all incident cases of melanoma occurring in Florida during 1994 whose stage at diagnosis was available (N = 1884). We used multiple logistic regression to determine the effects of sociodemographic characteristics on the odds of late-stage (regional or distant metastases) diagnosis. RESULTS: There were 243 patients (12.9%) diagnosed as having melanoma that had metastasized to either regional lymph nodes or distant sites. Patients who were unmarried (odds ratio, 1.5; P= .01), male (odds ratio, 2.2; P<.001), or smokers (odds ratio, 2.2; P<.001) or who resided in communities with lower median educational attainment (odds ratio, 1.5; P= .048) had greater odds of having a late-stage diagnosis. CONCLUSIONS: To detect these cancers at an earlier stage and improve outcomes, there should be increased educational efforts directed toward physicians who treat these patients. A recognition that there may be additional risk factors for late-stage diagnosis, beyond the established risk factors, such as family history and excess sun exposure, should be included in the initial assessment. Specific public education efforts should also be targeted to these patients to increase their self-surveillance and surveillance of their partners.     

Staphylococcus aureus bacteremia in older adults: predictors of 7-day mortality and infection with a methicillin-resistant strain.

OBJECTIVES: To determine the predictors of 7-day mortality in older adult patients with Staphylococcus aureus bacteremia after controlling for comorbidity using the Charlson weighted index of comorbidity (WIC) and to identify the risk factors associated with bacteremia due to methicillin-resistant S. aureus (MRSA). DESIGN. Retrospective cohort study from January 2003 until December 2004. SETTING. Two tertiary care, university-affiliated hospitals. METHODS. One hundred thirty-five hospitalized patients with S. aureus bacteremia were included in the study. All patients who were 60 years or older and had 1 or more blood cultures positive for S. aureus were included in the study. The primary outcome was death 7 days after the onset of S. aureus bacteremia. RESULTS. Twenty-one patients (15.6%) died within 7 days after the onset of S. aureus bacteremia. Seventy-four patients (56.1%) had MRSA bacteremia. Multivariate analysis identified 3 independent determinants of 7-day mortality: Charlson WIC score greater than 5 (odds ratio [OR], 3.6 [95% confidence interval {CI}, 1.1-11.2]; P=.03), previous hospitalization in the past 3 months (OR, 5.0 [95% CI, 1.1-25.1]; P=.04), and altered mental status at the onset of S. aureus bacteremia (OR, 13.6 [95% CI, 2.9-64.6]; P=.001). Multivariate analysis identified previous hospitalization in the past 3 months (OR, 2.6 [95% CI, 1.1-5.9]; P=.02), residence in a long-term care facility (OR, 4.5 [95% CI, 1.7-12.3]; P=.003), and altered mental status at the onset of S. aureus bacteremia (OR, 2.5 [95% CI, 1.5-5.6]; P=.02) to be independently associated with the presence of MRSA. CONCLUSIONS: The Charlson WIC is significantly associated with increased mortality of S. aureus bacteremia in older adults. Previous hospitalization in the past 3 months, residence in a long-term care facility, and altered mental status should be used as a guidance for empirical vancomycin therapy and application of infection control measures in older adults with suspected S. aureus bacteremia.     

Antecedents of macrosomia

Summary. Antecedents of high birthweight (macrosomia) were studied using the state birth certificates of White singleton infants born in three large metropolitan counties of Washington State from 1984 to 1986. Cases consisted of 2082 live-born macrosomic infants, defined by a birthweight of over 4.5 kg. A random sample of 4440 live births with birthweights of 2.5-4.0kg was selected as a comparison group. Estimates for the independent risks associated with gestational and established diabetes, male sex, parity, duration of gestation, maternal smoking during pregnancy, maternal age, and median income of maternal residential area were obtained and combined in a single logistic model. Maternal smoking was associated with a decreased risk of macrosomia (OR 0.4, 95% CI 0.3-0.5). Established diabetes (OR 6.4, 95% CI 2.7–15.4), gestational diabetes (OR 3.2, 95% CI 2.1–5.1) and male sex of the infant (OR 2.4, 95% CI 2.2-2.7) were associated with an increased risk. Increasing parity was related to an increasing risk from para one (OR 1.4, 95% 1.2-1.6) to para six and greater (OR 3.3, 95% CI 1.5–7.4). Increasing duration of gestation was associated with an increasing risk from 33–36 weeks (OR 0.8, 95% CI 0.5-1.2) to 43–45 weeks (OR 3.3, 95% CI 2.5-4.2). Maternal age, median income of maternal area of residence, and maternal marital status were not significantly associated with macrosomia.     

Cigarette smoking and alcohol consumption in the aetiology of uterine cervical cancer

A case-control study of uterine cervical cancer was conducted using 331 cases and 993 age-matched controls identified through the Missouri Cancer Registry during 1984-1986. Patients with smoking- or alcohol-related cancers were excluded from the control series. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (Cls) after adjustment for age, cigarette smoking, alcohol consumption, and stage at diagnosis. A dose-response relation was observed between intensity of cigarette smoking and invasive cervical cancer, with light and heavy smokers having elevated risks (OR = 2.2, 95% Cl = 1.4-3.6 and OR = 3.9, 95% Cl = 2.7-5.6, respectively). Former smokers had less elevated risk (OR = 1.7, 95% Cl = 1.0-2.9), a finding consistent with a greater effect of tobacco smoke on late-stage carcinogenesis. Similar results were obtained in age- and control site-specific analyses. Further, the age-specific data suggested a dose-response relation between duration of smoking and invasive cervical cancer. An association between alcohol consumption and invasive cervical cancer was not observed.     

Differences in Late‐Stage Diagnosis,Treatment, and Colorectal Cancer‐Related Death Between Rural and Urban African Americans and Whites in Georgia

Purpose: Disparities in health outcomes due to a diagnosis of colorectal cancer (CRC) have been reported for a number of demographic groups. This study was conducted to examine the outcomes of late‐stage diagnosis, treatment, and cancer‐related death according to race and geographic residency status (rural vs urban). Methods: This study utilized cross‐sectional and follow‐up data from the Surveillance, Epidemiology, and End Results (SEER) Program for all incident colon and rectal tumors diagnosed for the Atlanta and Rural Georgia Cancer Registries for the years 1992‐2007. Findings: Compared to whites, African Americans had a 40% increased odds (OR, 1.40; 95% CI, 1.30‐1.51) of late‐stage diagnosis, a 50% decreased odds (OR, 0.50; 95% CI, 0.37‐0.68) of having surgery for colon cancer, and a 67% decreased odds (OR, 0.33; 95% CI, 0.25‐0.44) of receiving surgery for rectal cancer. Rural residence was not associated with late stage at diagnosis or receipt of treatment. African Americans had a slightly increased risk of death from colon cancer (HR, 1.11; 95% CI, 1.00‐1.24) and a larger increased risk of death due to rectal cancer (HR, 1.24; 95% CI, 1.14‐1.35). Rural residents experienced a 15% increased risk of death (HR, 1.15; 95% CI, 1.01‐1.32) due to colon cancer. Conclusions: Further investigations should target African Americans and rural residents to gain insight into the etiologic mechanisms responsible for the poorer CRC outcomes experienced by these 2 segments of the population.     

The association between state income inequality and worse health is not confounded by race

BACKGROUND: The relationship between income inequality and health across US states has been challenged recently on grounds that this relationship may be confounded by the effect of racial composition, measured as the proportion of the state's population who are black. METHODS: Using multilevel statistical models, we examined the association between state income inequality and poor self-rated health. The analysis was based on the pooled 1995 and 1997 Current Population Surveys, comprising 201 221 adults nested within 50 US states. RESULTS: Controlling for the individual effects of age, sex, race, marital status, education, income, health insurance coverage, and employment status, we found a significant effect of state income inequality on poor self-rated health. For every 0.05-increase in the Gini coefficient, the odds ratio (OR) of reporting poor health increased by 1.39 (95% CI: 1.26, 1.51). Additionally controlling for the proportion of the state population who are black did not explain away the effect of income inequality (OR = 1.30; 95% CI: 1.15, 1.45). While being black at the individual level was associated with poorer self-rated health, no significant relationship was found between poor self-rated health and the proportion of black residents in a state. CONCLUSION: Our finding demonstrates that neither race, at the individual level, nor racial composition, as measured at the state level, explain away the previously reported association between income inequality and poorer health status in the US.     

Antecedents of macrosomia.

Antecedents of high birthweight (macrosomia) were studied using the state birth certificates of White singleton infants born in three large metropolitan counties of Washington State from 1984 to 1986. Cases consisted of 2082 live-born macrosomic infants, defined by a birthweight of over 4.5 kg. A random sample of 4440 live births with birthweights of 2.5-4.0 kg was selected as a comparison group. Estimates for the independent risks associated with gestational and established diabetes, male sex, parity, duration of gestation, maternal smoking during pregnancy, maternal age, and median income of maternal residential area were obtained and combined in a single logistic model. Maternal smoking was associated with a decreased risk of macrosomia (OR 0.4, 95% CI 0.3-0.5). Established diabetes (OR 6.4, 95% CI 2.7-15.4), gestational diabetes (OR 3.2, 95% CI 2.1-5.1) and male sex of the infant (OR 2.4, 95% CI 2.2-2.7) were associated with an increased risk. Increasing parity was related to an increasing risk from para one (OR 1.4, 95% 1.2-1.6) to para six and greater (OR 3.3, 95% CI 1.5-7.4). Increasing duration of gestation was associated with an increasing risk from 33-36 weeks (OR 0.8, 95% CI 0.5-1.2) to 43-45 weeks (OR 3.3, 95% CI 2.5-4.2). Maternal age, median income of maternal area of residence, and maternal marital status were not significantly associated with macrosomia.     

Risk factors for laryngeal cancer

This case-control study comprised 100 histologically verified laryngeal cancer patients and 100 hospital controls matched with cases by sex, age and place of residence. The following variables were tested for their association with cancer of the larynx: marital status, educational level, hard liquor consumption, cigarette smoking, unfavorable working conditions, sudden and frequent temperature changes at work, cold housing, loud speech at work, frequent hoarseness, frequent and persistent cough, persistently swollen neck glands, tonsillectomy and laryngeal surgery. According to conditional logistic regression analysis, significant association with laryngeal cancer was found for unfavourable working conditions for more than 10 years (OR=4.36; 95% CI=1.92–9.91), hard liquor consumption for more than 5 years (OR=2.59; 95% CI=1.14–5.87), cigarette smoking for more than 10 years (OR=7.29; 95% CI=2.41–22.09), tonsillectomy (OR=4.80; 95% CI=1.61–14.30) and frequent and persistent cough prior to disease (OR=8.17; 95% CI=1.72–38.76).     

Acculturation and Cancer Screening Among Asian Americans: Role of Health Insurance and Having a Regular Physician

Cancer is the leading cause of death among Asian Americans, but screening rates are significantly lower in Asians than in non-Hispanic Whites. This study examined associations between acculturation and three types of cancer screening (colorectal, cervical, and breast), focusing on the role of health insurance and having a regular physician. A cross-sectional study of 851 Chinese, Korean, and Vietnamese Americans was conducted in Maryland. Acculturation was measured using an abridged version of the Suinn–Lew Asian Self-Identity Acculturation Scale, acculturation clusters, language preference, length of residency in the US, and age at arrival. Age, health insurance, regular physician, gender, ethnicity, income, marital status, and health status were adjusted in the multivariate analysis. Logistic regression analysis showed that various measures of acculturation were positively associated with the odds of having all cancer screenings. Those lived for more than 20 years in the US were about 2–4 times [odds ratio (OR) and 95 % confidence interval (CI) colorectal: 2.41 (1.52–3.82); cervical: 1.79 (1.07–3.01); and breast: 2.11 (1.25–3.57)] more likely than those who lived for less than 10 years to have had cancer screening. When health insurance and having a regular physician were adjusted, the associations between length of residency and colorectal cancer [OR 1.72 (1.05–2.81)] was reduced and the association between length of residency and cervical and breast cancer became no longer significant. Findings from this study provide a robust and comprehensive picture of AA cancer screening behavior. They will provide helpful information on future target groups for promoting cancer screening.     

Hospice Use by Hispanic and Non-Hispanic White Cancer Decedents

Objective. To investigate rates of hospice use between Hispanic and non-Hispanic white Medicare beneficiaries diagnosed with cancer using data from a large, population-based study.
Data Sources. Secondary data from the linked SEER-Medicare database including the SEER areas of Los Angeles, San Francisco, and San Jose–Monterey, California, and the state of New Mexico. All subjects were Hispanic or non-Hispanic whites, aged 67 and older, had a cancer diagnosis of breast, colorectal, lung, or prostate cancer from 1991–1996, and died of cancer from 1991–1998.
Study Design. This study employed a retrospective cohort design to compare rates of hospice use between Hispanics and non-Hispanic whites across patient characteristics and over time.
Principal Findings. Rates of hospice use were similar for Hispanics (39.2 percent) and non-Hispanic whites (41.5 percent). In a bivariate logistic regression model, Hispanics were significantly less likely to use hospice than non-Hispanic whites (OR 0.91; 95 percent CI 0.85–0.97). However, after adjusting for age, marital status, sex, educational attainment, income, urban versus rural residence, and type of insurance using multivariate logistic regression analysis, the estimated odds for being a hospice user among Hispanics is similar to the odds of being a hospice user among non-Hispanic whites (OR 1.05; 95 percent CI 0.98–1.13). Stratified analyses revealed significant differences between ethnic groups in the use of hospice by type of insurance and SEER area, indicating interactions between ethnicity and these variables.
Conclusions. Our findings indicate similar rates of hospice use for Hispanics and non-Hispanic whites diagnosed with one of the four leading cancers. Additional studies from other national registries may be necessary to confirm these findings.     

Acutely injured patients with trauma in Massachusetts: differences in care and mortality, by insurance status.

OBJECTIVES. This study was designed to determine whether resource use and mortality differed by insurance status for patients with acute trauma. METHODS. All adults emergently hospitalized in Massachusetts during 1990 with acute trauma (n = 15,008) were examined. RESULTS. After adjustment for confounders, uninsured patients were as likely to receive care in an intensive care unit as were patients with private insurance (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.85, 1.11) but were less likely to undergo an operative procedure (OR = 0.68, 95% CI = 0.63, 0.74) or physical therapy (OR = 0.61, 95% CI = 0.57,0.67) and were more likely to die in a hospital (OR = 2.15, 95% CI = 1.44, 3.19). Compared with patients with private insurance, those with Medicaid were less likely to receive an operative procedure (0.85, 0.75-0.97), were equally likely to receive care in an intensive care unit (OR = 1.05, 95% CI = 0.86, 1.30) or physical therapy (OR = 0.90, 95% CI = 0.79, 1.02), and were no more likely to die (OR = 1.28, 95% CI = 0.69,2.39). CONCLUSIONS. These results suggest that the uninsured receive less trauma-related care and have a higher mortality rate. The excess mortality in uninsured patients may be avoided if their resource use is increased to that of insured patients.     

Health Insurance and Chronic Conditions in Low-Income Urban Whites

Little is known about how health insurance contributes to the prevalence of chronic disease in the overlooked population of low-income urban whites. This study uses cross-sectional data on 491 low-income urban non-elderly non-Hispanic whites from the Exploring Health Disparities in Integrated Communities—Southwest Baltimore (EHDIC-SWB) study to examine the relationship between insurance status and chronic conditions (defined as participant report of ever being told by a doctor they had hypertension, diabetes, stroke, heart attack, anxiety or depression, asthma or emphysema, or cancer). In this sample, 45.8 % were uninsured, 28.3 % were publicly insured, and 25.9 % had private insurance. Insured participants had similar odds of having any chronic condition (odds ratios (OR) 1.06; 95 % confidence intervals (CI) 0.70–1.62) compared to uninsured participants. However, those who had public insurance had a higher odds of reporting any chronic condition compared to the privately insured (OR 2.29; 95 % CI 1.21–4.35). In low-income urban areas, the health of whites is not often considered. However, this is a significant population whose reported prevalence of chronic conditions has implications for the Medicaid expansion and the implementation of health insurance exchanges.