Lack of private health insurance is associated with higher mortality from cancer and other chronic diseases,poor diet quality,and inflammatory biomarkers in the United States |
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| Institution: | 1. The Ohio State University, College of Medicine, Division of Health Sciences and Medical Dietetics, Columbus, OH, United States;2. The Ohio State University, College of Medicine, Department of Family Medicine, Columbus, OH, United States;3. The Ohio State University, College of Medicine, Division of Medical Oncology, Columbus, OH, United States;4. The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States;1. Propel Centre for Population Health Impact, University of Waterloo, Canada;2. School of Public Health and Health Systems, University of Waterloo, Canada;3. Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, United States;4. Statistics and Actuarial Sciences, University of Waterloo, Canada;1. Indiana University School of Medicine, Department of Surgery, Indianapolis, IN;2. Indiana University School of Medicine Division of Hematology and Oncology, Indianapolis, IN;3. VA HSR&D Center for Health Information and Communication, Indianapolis, IN;1. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States;2. Division of Health Interview Statistics, National Center for Health Statistics, Hyattsville, MD, United States;3. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States;4. Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, United States;5. Information Management Services, Inc., Calverton, MD, United States;6. Office of Disease Prevention, National Institutes of Health, Bethesda, MD, United States;1. Center for Health Behavior Research, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS, United States;2. Walking Behavior Laboratory, Population and Public Health Sciences, Pennington Biomedical Research Center, Baton Rouge, LA, United States |
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| Abstract: | ObjectiveThe lack of health insurance reduces access to care and often results in poorer health outcomes. The present study simultaneously assessed the effects of health insurance on cancer and chronic disease mortality, as well as the inter-relationships with diet, obesity, smoking, and inflammatory biomarkers. We hypothesized that public/no insurance versus private insurance would result in increased cancer/chronic disease mortality due to the increased prevalence of inflammation-related lifestyle factors in the underinsured population.MethodsData from the Third National Health and Nutrition Examination Survey participants (NHANES III;1988–1994) were prospectively examined to assess the effects of public/no insurance versus private insurance and inflammation-related lifestyle factors on mortality risk from cancer, all causes, cardiovascular disease (CVD) and diabetes. Cox proportional hazards regression was performed to assess these relationships.ResultsMultivariate regression analyses revealed substantially greater risks of mortality ranging from 35% to 245% for public/no insurance versus private insurance for cancer (HR = 1.35; 95% CI = 1.09,1.66), all causes (HR = 1.54; 95% CI = 1.39,1.70), CVD (HR = 1.62; 95% CI = 1.38,1.90) and diabetes (HR = 2.45; 95% CI = 1.45,4.14). Elevated CRP, smoking, reduced diet quality and higher BMI were more prevalent in those with public insurance, and were also associated with increased risks of cancer/chronic disease mortality.DiscussionInsurance status was strongly associated with cancer/chronic disease mortality after adjusting for lifestyle factors. The results suggest that inadequate health insurance coverage results in a substantially greater need for preventive strategies that focus on tobacco control, obesity, and improved dietary quality. These efforts should be incorporated into comprehensive insurance coverage programs for all Americans. |
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