Abstract 15652: Insurance Status Alone Does Not Explain Increasing HF Mortality Among Young Adults

Abstract

Introduction: Heart failure (HF) mortality among young adults has been increasing since 2012. It is unknown if insurance status contributes to these trends. Hypothesis: Uninsured status contributes to rising HF mortality rates in young adults across US states over the last decade. Methods: State-level age-adjusted mortality rates for HF and all cardiovascular disease (CVD) in adults aged 25-64 from 2010-2020 were obtained from the National Center for Health Statistics. All deaths across fifty states and the District of Columbia (DC) were included, averaging 3.3 million individuals per year. Annual estimates of the percentage of uninsured adults ages 25-64 (% uninsured) from the US Census were merged with mortality data by state and year. We examined cross-sectional associations of % uninsured with HF and CVD mortality in each year. We further examined the longitudinal association of % uninsured and mortality outcomes across years using linear regression models with generalized estimating equations to account for the longitudinal design. Results: Across n=51 US states and DC, the age-adjusted HF mortality rate increased from a mean of 6.48 in 2010 to 7.54 in 2020 (p<0.001), while the age-adjusted all-cause CVD mortality rate increased from 78.71 in 2010 to 88.91 in 2020 (p<0.001). Over the same period, the % uninsured decreased from 19% in 2010 to 11% in 2020 (p<0.001). In 3 of 10 years, there was a significant association between % uninsured and HF mortality (β ranging from 15.94 to 25.01 deaths per 100,000 in 2010, 2015, and 2020; p<0.01,) and CVD mortality (β ranging from 166.48 to 258.48 deaths per 100,000 in 2010, 2015, and 2020; p<0.01). The longitudinal association between % uninsured and HF mortality was not significant (β=1.81 deaths per 100,000; p=0.44). Conclusion: Uninsured status is associated with HF and overall CVD mortality across US states in certain years, however, there is no association between uninsured status and HF and CVD mortality rates from 2010-2020.