Lack of health insurance and decline in overall health in late middle age
Lack of health insurance and decline in overall health in late middle age
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DOI：
10.1056/nejmsa002887
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发表时间：
2001-10-11
影响因子：
158.5
通讯作者：
Dor, A
中科院分区：
文献类型：
--
作者：
Baker, DW;Sudano, JJ;Dor, A
背景：美国50多岁和60多岁的成年人没有医疗保险的人数正在增加。这一群体可能特别容易受到没有保险的不良影响。方法：我们进行了一项前瞻性队列研究，使用来自健康与退休研究的文件，这是一项1992年对51至61岁的成年人进行的全国性调查。我们确定了1992年至1996年期间连续无保险（1992年和1994年无保险）、间歇性无保险（1992年或1994年无保险）和连续有保险的参与者总体健康状况大幅下降和新身体困难发展的风险。在调整了基线社会人口因素、既往医疗状况和与健康相关的行为类型（如吸烟和饮酒）后，我们使用逻辑回归来确定未投保对健康结果的独立影响。结果：我们分析了7577名参与者的数据。717名连续无保险的参与者和825名间歇无保险的参与者比6035名连续有保险的参与者更有可能在1992年至1996年期间整体健康状况大幅下降(三组分别为21.6%，16.1%和8.3%；P
Background: The number of adults in their 50s and 60s in the United States who do not have health insurance is increasing. This group may be particularly vulnerable to the ill effects of being uninsured.Methods: We conducted a prospective cohort study using files from the Health and Retirement Study, a national survey of adults who were 51 to 61 years old in 1992. We determined the risks of a major decline in overall health and of the development of new physical difficulties between 1992 and 1996 for participants who were continuously uninsured (uninsured in 1992 and in 1994), those who were intermittently uninsured (uninsured either in 1992 or in 1994), and those who were continuously insured. We used logistic regression to determine the independent effects of being uninsured on health outcomes after adjustment for base-line sociodemographic factors, preexisting medical conditions, and types of health-related behavior such as smoking and alcohol use.Results: We analyzed data for 7577 participants. The 717 continuously uninsured participants and the 825 intermittently uninsured participants were more likely than the 6035 continuously insured participants to have a major decline in overall health between 1992 and 1996 (21.6 percent, 16.1 percent, and 8.3 percent of the three groups, respectively; P