A recent study shows that uninsured American adults with chronic illnesses often go undiagnosed or undertreated, leading to an increased risk of costly, disabling and even lethal complications of their disease.
The study, publishing online in Health Affairs, found that 46 percent of uninsured people with diabetes and 52 percent of those with high cholesterol did not know they had the diseases. This contrasts with 23 percent of insured people with diabetes and 29.9 percent of those with high cholesterol.
“Our previous work demonstrated 45,000 deaths annually are linked to lack of health insurance,” said lead author Andrew Wilper, of the University of Washington Medical School. “Our new findings suggest a mechanism for this increased risk of death among the uninsured. They're not getting life-saving care."
The study also found that the uninsured are more likely to be undertreated than their insured counterparts: 58.3 percent vs. 51.4 percent were not controlling their high blood pressure, and 77.5 percent vs. 60.4 percent were not adequately treating their high cholesterol.
Researchers based at Harvard Medical School and the affiliated Cambridge Health Alliance analyzed data on 15,976 U.S. non-elderly adults from the National Health and Nutrition Examination Survey (NHANES), a Centers for Disease Control and Prevention program, between 1999 and 2006.
Being insured was not associated with a widely used measure of diabetes control (a hemoglobin A1c level below 7), a finding the authors attribute to the stringent definition of good diabetes control used in the NHANES survey.
Even with good medical care, many diabetics fail to achieve proper hemoglobin A1c levels. Using less stringent hemoglobin A1c thresholds of 8 and 9, uninsured adults had significantly more problems controlling their blood sugar levels than their insured counterparts, the researchers found.
"The uninsured suffer the most, but even Americans with insurance have shocking rates of undertreatment, in part because high co-payments and deductibles often make care and medications unaffordable,” said Steffie Woolhandler, a professor of medicine at Harvard and the study's co-author. “We need to upgrade coverage for the insured, as well as covering the uninsured. Only single-payer national health insurance would make care affordable for the tens of millions of Americans with chronic illnesses."