scholarly journals Association Between Health Insurance and Race With Mortality From Trauma: a Retrospective Study

2021 ◽  
Author(s):  
Ibrahim Gwarzo ◽  
Maria Perez-Patron ◽  
Xiaohui Xu ◽  
Tiffany Radcliff ◽  
Jennifer Horney
Keyword(s):  
Health Insurance ◽  
Trauma Registry ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Registry Data ◽  
Insurance Status ◽  
Health Insurance Status ◽  
Trauma Mortality ◽  
Race Ethnicity ◽  
Related Mortality

Abstract Background: The population health implications of the growing burden of trauma-related mortality may be influenced by access to health insurance coverage, and demographic characteristics such as race and ethnicity. We investigated the effects of health insurance status and race/ethnicity on the risk of mortality among trauma victims in Texas.Methods: Using Texas trauma registry data from 2014 - 2016, we categorized health insurance coverage into private, public, and uninsured, and categorized patients with serious injuries into Non-Hispanic Whites, Non-Hispanic Blacks, Hispanics Any-Race, and Others. Multivariate logistic regression was used to estimate the effects of health insurance status and race/ethnicity on mortality, controlling for age, gender, severity of the trauma, cause of trauma, presence of comorbid conditions, trauma center designation, presence of a traumatic brain injury (TBI), and severity of a TBI. Results: From January 1, 2014, to December 31, 2016, there were 415,159 trauma cases in Texas; 8,827 (2.1%) were fatal. Among patients with at least a moderate injury, 24, 606 (17.4%) were uninsured, and 98, 237 (69.4%) identified as Non-Hispanic White. In the multivariate analysis, Hispanics of any race and Non-Hispanic Blacks had higher adjusted odds of trauma mortality compared to Non-Hispanic Whites [ORHispanics= 1.25: 95% CI (1.16 – 1.36)] [ORBlacks= 2.11: 95% CI (1.87 – 2.37)]. Similarly, compared to privately insured, uninsured patients had 86% higher odds of trauma-related death [OR= 1.86: 95% CI (1.66 – 2.05)]. The effects of lack of health insurance on trauma mortality varied across race/ethnicity of the victims; uninsured Non-Hispanic Blacks had disproportionately higher adjusted odds of trauma mortality than uninsured Whites. Conclusion: Using Texas trauma registry data, we found significant disparities in trauma-related mortality risk based on race/ethnicity and health insurance coverage. The identification of trauma mortality inequalities could inform the design and implementation of future public health interventions.

scholarly journals Health Insurance Coverage Better Protects Blacks than Whites against Incident Chronic Disease

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 40 ◽  
Author(s):  
Shervin Assari ◽  
Hamid Helmi ◽  
Mohsen Bazargan
Keyword(s):  
Health Insurance ◽  
Protective Effect ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Relative Advantage ◽  
Linear Regression Models ◽  
Socioeconomic Resources ◽  
Health Insurance Status ◽  
Race Ethnicity

Although the protective effect of health insurance on population health is well established, this effect may vary based on race/ethnicity. This study had two aims: (1) to test whether having health insurance at baseline protects individuals over a 10-year period against incident chronic medical conditions (CMC) and (2) to explore the race/ethnic variation in this effect. Midlife in the United States (MIDUS) is a national longitudinal study among 25–75 year-old American adults. The current study included 3572 Whites and 133 Blacks who were followed for 10 years from 1995 to 2004. Race, demographic characteristics (age and gender), socioeconomic status (educational attainment and personal income), and health insurance status were measured at baseline. Number of CMC was measured in 1995 and 2005. Linear regression models were used for data analysis. In the overall sample, having health insurance at baseline was inversely associated with an increase in CMC over the follow up period, net of covariates. Blacks and Whites differed in the magnitude of the effect of health insurance on CMC incidence, with a stronger protective effect for Blacks than Whites. In the U.S., health insurance protects individuals against incident CMC; however, the health return of health insurance may depend on race/ethnicity. This finding suggests that health insurance may better protect Blacks than Whites against developing more chronic diseases. Increasing Blacks’ access to health insurance may be a solution to eliminate health disparities, given they are at a relative advantage for gaining health from insurance. These findings are discussed in the context of Blacks’ diminished returns of socioeconomic resources. Future attempts should test replicability of these findings.

scholarly journals The convergence of racial and income disparities in health insurance coverage in the United States

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

scholarly journals Age-related Differences in Breast Cancer Mortality according to Race/Ethnicity, Insurance, and Socioeconomic Status

2019 ◽  
Author(s):  
Yazmin San Miguel ◽  
Scarlett Lin Gomez ◽  
James D. Murphy ◽  
Richard B. Schwab ◽  
Corinne McDaniels-Davidson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Socioeconomic Status ◽  
Health Insurance ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Insurance Status ◽  
Younger Patients ◽  
Younger Women ◽  
Health Insurance Status ◽  
Race Ethnicity

Abstract Purpose We assessed breast cancer mortality in older versus younger women according to race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance status. Methods The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and 2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate hazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus younger (<60 years) patients separately by race/ethnicity, nSES, and health insurance status. Results Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment, which varied in magnitude by race/ethnicity (P-interaction<0.0001). Comparing older to younger patients, higher mortality differences were shown for non-Hispanic white (HR=1.43; 95% CI, 1.36-1.51) and Hispanic women (HR=1.37; 95% CI, 1.26-1.50) and lower differences for non-Hispanic blacks (HR=1.17; 95% CI, 1.04-1.31) and Asians/Pacific Islanders (HR=1.15; 95% CI, 1.02-1.31). HRs comparing older to younger patients varied by insurance status (P-interaction<0.0001), with largest mortality differences observed for privately insured women (HR=1.51; 95% CI, 1.43-1.59) and lowest in Medicaid/military/other public insurance (HR=1.18; 95% CI, 1.10-1.26). No age differences were shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata. Conclusion Our results provide evidence for the continued disparity in black-white breast cancer mortality, which is magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with uninsured women having the highest risk for breast cancer death, regardless of age.

scholarly journals Impact of local health insurance schemes on primary care management and control of hypertension: a cross-sectional study in Shenzhen, China

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031098 ◽  
Author(s):  
Haitao Li ◽  
Zhu Wu ◽  
Xia Hui ◽  
Yanhong Hu
Keyword(s):  
Primary Care ◽  
Social Capital ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Hypertension Management ◽  
Insurance Status ◽  
Local Health ◽  
Hypertensive Patients ◽  
And Control

BackgroundIn China, the local health insurance coverage is usually related to timely reimbursement of hypertensive care in primary care settings, while health insurance that is not local could represent an obstacle for accessibility and affordability of primary care for hypertensive patients.ObjectiveTo investigate whether local health insurance schemes have a positive impact on hypertension management and control.DesignWe performed an on-site, face-to-face, patients survey in community health centres (CHCs) in Shenzhen, China.Setting and participantsHypertensive patients seeking healthcare from CHCs were selected as study participants using a systematic sampling design.Main measuresWe obtained information about insurance status, social capital, drug treatment and control of hypertension. Multivariable stepwise logistic regression models were constructed to test the associations between insurance status and hypertension management, as well as insurance status and social capital.ResultsA total of 867 participants were included in the final study analysis. We found that the participants covered by local insurance schemes were more likely to be managed in primary care facilities (61.1% vs 81.9%; OR=2.58, 95% CI: 1.56 to 4.28), taking antihypertensive drugs (77.2% vs 88.0%; OR=2.23, 95% CI: 1.37 to 3.62) and controlling blood pressure (43.0% vs 52.4%; OR=1.46, 95% CI: 1.03 to 2.07) when compared with those with insurance coverage that is not local. The participants covered by local insurance schemes reported a higher score of perceived generalised trust than those without (4.23 vs 3.97; OR=0.74, 95% CI: 0.53 to 0.86).ConclusionOur study demonstrates that local health insurance coverage could help improve management and control of hypertension in a primary care setting. Policymakers suggest initiating social interventions for better management and control of hypertension at the primary care level, although the causal pathways across insurance status, social capital and control of hypertension deserve further investigations.

Accuracy in Self-Reported Health Insurance Coverage among Medicaid Enrollees

2008 ◽  
Vol 45 (4) ◽  
pp. 438-456 ◽  
Author(s):  
Kathleen Thiede Call ◽  
Gestur Davidson ◽  
Michael Davern ◽  
E. Richard Brown ◽  
Jennifer Kincheloe ◽  
...  
Keyword(s):  
Health Insurance ◽  
Multivariate Analyses ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Insurance Status ◽  
Related Factors ◽  
Reporting Error ◽  
Reported Health

The largest portion of the Medicaid undercount is caused by survey reporting error—that is, Medicaid recipients misreport their enrollment in health insurance coverage surveys. In this study, we sampled known Medicaid enrollees to learn how they respond to health insurance questions and to document correlates of accurate and inaccurate reports. We found that Medicaid enrollees are fairly accurate reporters of insurance status and type of coverage, but some do report being uninsured. Multivariate analyses point to the prominent role of program-related factors in the accuracy of reports. Our findings suggest that the Medicaid undercount should not undermine confidence in survey-based estimates of uninsurance.

Disparities in Mammography Use Among US Women Aged 40???64 Years, by Race, Ethnicity, Income, and Health Insurance Status, 1993 and 2005

Medical Care ◽  
2008 ◽  
Vol 46 (7) ◽  
pp. 692-700 ◽  
Author(s):  
Susan A. Sabatino ◽  
Ralph J. Coates ◽  
Robert J. Uhler ◽  
Nancy Breen ◽  
Florence Tangka ◽  
...  
Keyword(s):  
Health Insurance ◽  
Insurance Status ◽  
Health Insurance Status ◽  
Race Ethnicity ◽  
Mammography Use
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