Introduction:
Lack of health insurance is associated with reduced access to medical care and increased mortality. Chronic illness is associated with sudden death, a major cause of natural death. Insurance status of sudden death victims has not been characterized.
Hypothesis:
Uninsured compared to insured sudden death victims will have more chronic illnesses.
Methods:
From 2013-2015, emergency medical services-attended out of hospital deaths among ages 18-64 in Wake County, NC were screened to adjudicate sudden deaths. Medical records were reviewed for demographic, clinical, and health insurance status data. Insurance status was characterized as private, public, or no insurance. Cases were excluded from the analysis if no information on insurance was available. Comparisons of demographic and clinical characteristics were made between the three insurance status groups using Student’s t-test and ANOVA for continuous and categorical variables, respectively.
Results:
Of 399 cases of sudden death, insurance status data was available for 130: 25 (19.2%) had no insurance, 62 (47.7%) had public insurance, 31 (23.8%) had private insurance, and 12 (9.2%) had insurance of unknown type. Uninsured victims had lower frequencies of hypertension, hyperlipidemia, and chronic respiratory disease than those with private or public insurance, and lower frequencies of diabetes mellitus, mental illness, and substance abuse than those publicly insured (Table 1). No significant differences were found in coronary artery disease, age, gender, race, marital status, or years of education.
Conclusion:
Uninsured sudden death victims have less chronic illnesses than those insured. This counterintuitive finding suggests that uninsured sudden death victims have undiagnosed chronic illnesses that are treatable and preventable and contribute to their death. Our results suggest that expanding health insurance among working age adults may reduce the incidence of sudden death.