Health Insurance Coverage Status Research Articles

Did Medicaid Reimbursements Shape the Effects of Medicaid Expansion on Access to Health Care Among the Low-Income Population?

Whether variation in Medicaid reimbursement fees influenced the impacts of the Medicaid expansions is not well understood. We examine whether changes in health care access associated with Medicaid expansion are different in states with comparatively high Medicaid reimbursement rates compared against expanding in states with lower Medicaid reimbursement rates. Using a difference-in-difference-in-difference (DDD or triple-difference) regression approach, we compare relative differences in Medicaid expansion effects between lower and higher reimbursement states. 512,744 low-income adults aged 20-64 in the 2011-2019 Behavioral Risk Factor Surveillance System. Health insurance coverage status, unmet medical needs due to cost, regular source for health care, and a regular/scheduled checkup within the past year. Medicaid expansion has significant and positive impacts on health coverage and access in both high- and low-fee states. In states with fee levels above the median Medicare-to-Medicaid ratios, expanding Medicaid eligibility reduced uninsurance rate by 15.2 percentage point (ppt, p < 0.01), shrank the cost-associated unmet medical need by 10.3 ppt (p < 0.01), improved access to usual source of care by 1.9 ppt (p < 0.1), and increased regular checkup by 14.4 ppt (p < 0.01), while such effects in low-fee states were 11.7 ppt (p < 0.01), 8.3 ppt (p < 0.01), 3.1 ppt (p < 0.1), and 12.3 ppt (p < 0.01), respectively. Our results suggest that Medicaid expansion effect on unmet medical need due to cost in higher-reimbursing states was 2.98 ppt (p < 0.05) larger than in lower-reimbursing states. Evidence suggests modest increases in health care access were more strongly associated with expansions in higher-fee states. Medicaid's fee structure should be considered as a factor influencing large-scale coverage expansions.

Comparison of Unemployment-Related Health Insurance Coverage Changes in Medicaid Expansion vs Nonexpansion States During the COVID-19 Pandemic

The COVID-19 pandemic has been associated with increased unemployment rates and long periods when individuals were without health insurance. Little is known about how Medicaid expansion facilitates Medicaid enrollment as a buffer to coverage loss owing to unemployment. To compare changes in health insurance coverage status associated with pandemic-related unemployment among previously employed adults in states that have vs have not expanded Medicaid eligibility. This cohort study included US adults aged 27 to 64 years who were employed at baseline in the 2020 to 2021 Current Population Survey's Annual Social and Economic Supplement, which included calendar years 2019 to 2020 (32 462 person-years). Data analyses were conducted between November 2021 and April 2022. Job loss (ie, new unemployment) experienced during 2020. Primary outcomes were coverage status (ie, uninsured status) and source of coverage (ie, employer sponsored, marketplace, and Medicaid). Using 2-way person-by-year fixed-effects regression models, changes in coverage status associated with unemployment in states that expanded Medicaid were compared with states that did not expand Medicaid. Additional analyses were performed based on prepandemic coverage status. The cohort included 16 231 adults (mean age, 46.8 [95% CI, 46.6-47.0] years; 51.6% women). New unemployment was associated with an increase of 2.9 (95% CI, 1.1-4.6) percentage points (P = .002) in the proportion of uninsured adults in Medicaid expansion states and an increase of 10.7 (95% CI, 2.4-18.9) percentage points (P = .01) in nonexpansion states. Workers were 5.4 (95% CI, 1.9-8.9) percentage points (P = .003) more likely to enroll in Medicaid after a job loss if they lived in a Medicaid expansion state compared with workers experiencing job loss in nonexpansion states. In this cohort study of US adults, unemployment-related Medicaid enrollment was more frequent in Medicaid expansion states during the COVID-19 pandemic. Medicaid expansion led to a smaller increase in uninsured adults because those who lost private insurance coverage (eg, employer sponsored) appeared more able to transition to Medicaid after job loss.

The Relationship between Religiosity and Cognitive Function among Chinese Older Adults in Chicago

Evidence suggests religiosity may be related to cognitive decline in older adults living in the US and China. However, the relationship between religiosity and cognitive function has not been tested in a Chinese community in the US. Immigration and isolation often cause diasporas to differ from communities where they currently reside and their origin. This study aims to determine the relationship between religiosity, cognitive function, and demographic attributes in a sample of older Chinese adults age 60 to 105 living in the Chicago area (N = 3157). Regression analysis showed participation in organized religion significantly predicted higher global cognitive function (β = 0.031, p < 0.001, N = 3051). Of all cognitive function measures including episodic memory (East Boston Memory Immediate and Delayed Recall Test), perceptual speed (Symbol Digit Modalities Test), working memory (Digit Backwards Test), cognitive impairment (Mini Mental State Examination), and a composite measure of (global cognition), the importance of religion only significantly predicted greater working memory capacity (β = 0.045, p = 0.003, N = 3058). Practicing religion at home had a nonsignificant relationship with all measures of cognitive function. All analyses controlled for the following covariates: gender, education, income, number of children, marital status, and health insurance coverage status. Findings suggest that among aspects of religiosity, organized religious involvement may have a positive association with higher cognitive function. Future research should explore between-population differences in the relationships of social factors, religiosity, and cognition function to determine what practices can best benefit older adults in various communities.

Measuring the Protective Effect of Health Insurance Coverage on Out-of-Pocket Expenditures During the COVID-19 Pandemic in the Peruvian Population.

Health insurance coverage is expected to protect individuals from out-of-pocket (OOP) expenditures, potentially preventing them from falling into poverty. However, to date, the effect of health insurance on OOP spending during the coronavirus disease 2019 (COVID-19) pandemic has not been fully explored. This study aimed to estimate differences in the proportion and the amount of OOP expenditures among Peruvians during the pre- and post-mandatory lockdown response to COVID-19 in 2020 according to the health insurance coverage status. This study utilized repeated cross-sectional data from the National Household Survey on Living and Poverty Conditions (ENAHO) from the first quarter of 2017 until the fourth quarter of 2020. The outcomes were (i) the proportion of individuals who incurred OOP expenditures and (ii) the monetary value of OOP expenditures. An interrupted time series analysis (ITS) and a quasi-experimental difference-in-difference (DID) analysis were performed to examine the outcomes among the control (individuals without health insurance) and treatment groups (individuals with health insurance) after the COVID-19 pandemic. ITS analysis showed that the proportion of individuals reporting OOP expenditures after implementation of mandatory lockdown due to COVID-19 in Peru decreased in both groups, but no difference in the slope trend was found (P=.916). The average quarterly amount of OOP spending increased in both groups, but no difference in the slope trend was found (P=.073). Lastly, the DID analysis showed that the mandatory lockdown was associated with a higher amount of OOP, but there was no evidence to indicate that the higher amount was different between the control and treatment groups. The mandatory lockdown in response to the COVID-19 was associated with a higher amount of OOP expenditures and a lower likelihood of incurring OOP expenditures. However, our findings suggest that health insurance coverage does not lower OOP expenditures or reduce the likelihood of incurring OOP expenditures.

The Relationship Between Unemployment and Health Insurance Coverage: Before and After the Affordable Care Act's Coverage Expansions.

The objective of this study was to determine whether the Affordable Care Act's (ACA) major coverage expansions mitigated the impact of unemployment on health insurance coverage status. A 2011-2019 versions of the American Community Survey developed by the University of Minnesota Integrated Public Use Microdata Series program. We use difference-in-difference-in-differences (ie, triple difference) regressions to compare changes in the short-run impacts of local unemployment rates before and after the ACA. Before the ACA, rises in local unemployment were associated with uninsurance due to losses in private coverage (ie, both nongroup and employer sponsored).Following the ACA's full implementation, the link between employment and coverage was attenuated by access to publicly subsidized qualified health plans on the ACA's nongroup market, and enhanced access to Medicaid in states that expanded. Our findings suggest protections from unemployment-linked uninsured spells are largest in states that expanded Medicaid. Expanded access to coverage under the ACA could mitigate the adverse effects on insurance status and access to care historically linked to job loss. However, should the ACA be repealed, many households stand to lose their ability to turn to Medicaid or subsidized nongroup coverage as safety-net resources to offset the burdens of job loss.

Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study.

To assess rates of and factors associated with traversing fundamental barriers to good medical outcomes and pharmacologic care in individuals with episodic migraine (EM) and chronic migraine (CM), including socioeconomic status and race. Barriers to good outcomes in migraine include the lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered a regimen with acute and preventive pharmacologic treatments (if indicated), and not avoiding medication overuse. The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal Internet-based survey. Respondents who met criteria for migraine consistent with the International Classification of Headache Disorders, 3rd edition, had a Migraine Disability Assessment score≥6, and provided health insurance coverage status were included in this analysis. Successfully traversing each barrier to care and the effects of sociodemographic characteristics were examined. Among 16,789 respondents with migraine, 9184 (54.7%; EM: 7930; CM: 1254) were eligible. Current headache consultation was reported by 27.6% (2187/7930) of EM and 40.8% (512/1254) of CM respondents. Among consulters, 75.7% (1655/2187) with EM and 32.8% (168/512) with CM were accurately diagnosed. Among diagnosed consulters, 59.9% (992/1655) with EM and 54.2% (91/168) with CM reported minimally appropriate acute and preventive pharmacologic treatment. Among diagnosed and treated consulters, in the EM group 31.8% (315/992) and in the CM group 74.7% (68/91) met medication overuse criteria. Only 8.5% (677/7930) of EM and 1.8% (23/1254) of CM respondents traversed all four barriers. Higher income was positively associated with likelihood of traversing each barrier. Blacks and/or African Americans had higher rates of consultation than other racial groups. Blacks and/or African Americans and multiracial people had higher rates of acute medication overuse. Efforts to improve care should focus on increasing consultation and diagnosis rates, improving the delivery of all appropriate guideline-based treatment, and avoidance of medication overuse.

Assessing Cardiometabolic Health Risk Among U.S. Children Who Live in Grandparent-Headed Households

Many interventions have been designed to leverage parent-caregivers as change agents for improving children’s cardiometabolic health (CMH), however very few have been designed to leverage grandparent-caregivers for that purpose. This is surprising since there has been a steady increase in children living in grandparent-headed households. As a first step in assessing the potential impact of interventions with grandparent-caregivers, we used data from the National Survey of Children’s Health (2018) to compare CMH measures in children living in grandparent-headed households with CMH measures in children living in parent-headed households. Our hypothesis was that CMH risk might be higher in grandparent households – given that research shows that grandparents taking over caregiving from parents is associated with worse overall health outcomes for both grandparents and their grandchildren. Additionally, since research indicates that children who experience ≥ 4 adverse childhood experiences (ACEs) have significantly worse health outcomes, we assessed levels of ACEs. Our analytic sample included children aged 10-17 years (n=14,941). Adjusting for age, sex, race/ethnicity, and health insurance coverage status, children living in grandparent households were more likely to be obese (Adjusted Odds Ratio [95% confidence interval]= 2.04 [1.02, 4.09]), exposed to secondhand smoke (2.32 [1.49, 3.59]), and less likely to meet recommended age-appropriate standards for sleep (0.42 [0.27, 0.67]). The children living in grandparent households were more likely to experience ≥ 4 ACEs (8.59 [5.42, 13.62]). Our results provide indirect evidence that interventions with grandparent-caregivers may be particularly critical for improving CMH risk in families.

A Cluster-Randomized Controlled Trial to Evaluate a Community-Based Healthy Eating and Nutrition Label Interpretation Intervention Among Latinx Immigrant Mothers and Their Daughters.

We evaluated outcomes from a healthy eating/nutrition label interpretation intervention among Latinx immigrant mothers and their daughters, aged 9-12years, in Alabama. Between May 2013-October 2017, this cluster randomized controlled trial assigned 299 mother-daughter dyads to either a healthy eating (intervention) or HPV vaccination (control) study arm. Participants attended four group sessions delivered in Spanish by Lay Health Educators covering portion sizes, healthy eating/cooking strategies, and nutrition label reading/interpretation. An individual session in participants' homes reviewed pantries and developed healthy eating plans. Identical interviewer-administered surveys were completed at baseline and 7-month follow-up by both study arms. Retention rate at follow-up was 93.4% in intervention arm (92.6% in control arm). Positive changes in healthy eating behaviors and proficiency in nutrition label interpretation were assessed. Adjusting for marital status, employment status, and health insurance coverage status, when compared to controls, mothers in the intervention arm had greater odds of increasing daily fruit and vegetable consumption (OR 3.66, 95% CI 2.14-6.27, p < 0.001), decreasing weekly fried food intake (OR 4.3, 95% CI 2.3-8.04, p < 0.001), decreasing daily sweetened beverages (OR 2.07, 95% CI 1.22-3.52, p < 0.01), increasing frequency of reading nutrition labels (OR 12.58, 95% CI 6.81-23.22, p < 0.001), and correctly interpreting nutrition labels (OR 4.45, 95% CI 2.64-7.48, p < 0.001). Significant positive changes in targeted behaviors were not observed among daughters. A community-based, culturally relevant intervention that includes nutrition label interpretation can positively influence eating habits among Latinx immigrant mothers.

Opioid overdose knowledge among college students in a high overdose death state

ABSTRACTThe goal of this study was to investigate university students’ knowledge about the identification of opioid overdose and actions to take in an overdose emergency. A cross-sectional, anonymous, 36-item survey was developed and administered to West Virginia University (WVU) students. Overdose knowledge was assessed using the Opioid Overdose Knowledge Scale (OOKS). Demographic information, health insurance coverage status, previously receiving an opioid prescription, and knowledge about West Virginia Good Samaritan laws were also collected. Online survey responses were collected via REDCap. The study sample (n = 214) was 90% white, 72.5% female, had a mean age of 24.8 years, and over half previously received a prescription opioid (51.9%). Additionally, 6.5% reported witnessing an overdose in the past year, and 15.9% previously received naloxone training. Overall, our participants had an average score of 30.9 out of 45 on the OOKS. Participants who previously received naloxone training scored higher overall on the OOKS than participants who did not (p < .001). Similarly, participants who previously received a prescription for an opioid also scored higher than participants who had never had a previous prescription for an opioid (p < .001). University students’ knowledge suggests that previous exposure to opioid prescriptions and naloxone training increase a student’s knowledge about opioid overdose. This information is not surprising; however, this does make the case that students may benefit from brief overdose education programs that could be implemented across university health education curricula. However, a larger effort may need to be implemented to encourage students to participate in such programs.

Moving towards universal health coverage: an assessment of unawareness of health insurance coverage status among reproductive-age women in rural northern Ghana

Abstract Background Ghana implemented a nationwide health insurance scheme in 2005 as part of efforts to ensure access to affordable and equitable health care without paying user fees at the point of service delivery. However, active enrolment has remained low even over a decade of implementing this policy. We aimed to understand some of the factors accounting for low active enrolment by examining the possibility that unawareness of insurance status could be a contributor among women from an impoverished rural setting. Methods We used cross-sectional data from reproductive-aged women from one of Ghana's poorest and remote regions. A two-stage sampling approach was used. First, the Ghana Statistical Service purposefully sampled and provided 66 predominantly rural enumeration areas from all districts the Upper East region except Kassena-Nankana East and West Districts. Guided by this sampling frame, a household listing of members in the sampled enumeration areas was done. Second, we sampled households proportional to the population size. Within sampled households, all females between the ages of 15 and 49 years were eligible to be interviewed. In the case of the two Kassena-Nankana Districts, sampling was done using Navrongo Health Research Center demographic surveillance data, from which a random sample of 2500 women was sampled. During the survey, two questions related to the National Health Insurance Scheme (NHIS) were asked: “Have you ever registered with the NHIS?” and “Do you currently have a valid NHIS card?” If the answer to the second question was yes, the interviewer requested to see the card and confirm its validity (cards must be renewed annually). We examined the prevalence and predictors of unawareness of health insurance status using descriptive statistics, a χ2 test of association, and regression analysis. Findings Data collection started on Oct 2, 2014, and ended on Jan 31, 2015. Of the 7693 respondents, 4900 (64%) who thought that they were actively enrolled in the NHIS could produce their insurance cards upon request. 1642 (33·5%) of these had invalid cards. Factors that significantly predicted unawareness of card invalidity were occupation, district of residence, and socioeconomic status. Farmers were the most likely to be unaware of their card validity status compared with all other occupations. Residents in five out of seven districts were less likely to be unaware of their insurance card validity. There was a consistent increase in the likelihood of unawareness with decreasing socioeconomic status. Interpretation Unawareness of insurance card invalidity is an important contributor to low active enrolment onto Ghana's national health insurance scheme. Educational campaigns aimed at improving active health insurance membership should include messages that are tailored to populations such as farmers and low socioeconomic groups. The unawareness disparities within districts in the studied region merit further investigation. Funding Doris Duke Charitable Foundation.

Self-reported healthcare provider utilization across United States Midwestern households

Understanding the relationships between health care provider usage and demographics of patients is necessary for the development of educational materials, outreach information, and programs targeting individuals who may benefit from services. This analysis identified relationships between health care provider usage and individual's demographics. A sample of Midwestern U.S. respondents (n = 1265) was obtained through the use of an online survey distributed February 12–26, 2016 and was targeted to be representative of the population of the Midwestern states sampled in terms of sex, age, income, and state of residence. Specific factors identified as significant in contributing to provider usage (in the past five years) differed across the eleven provider types studied. In the most commonly used practitioners (the general or primary physician), relationships between provider usage and age, income, health insurance coverage status, and having children in the household were identified. Furthermore, significant (and positive) correlations were identified between the usage of various practitioners; reporting the use of one type of practitioner studied was correlated positively with reporting the use of another type of health care provider studied in this analysis. This analysis provides insight into the relationships between health care provider usage and demographics of individuals, which can aid in the development of educational materials, outreach programs, and policy development.

QuickStats:Percentage* of Adults Aged 18–64 Years with Two or More Visits to the Emergency Department† in the Past 12 Months, by Health Insurance Coverage Status,§ and Race/Ethnicity¶ — National Health Interview Survey,** 2014

<i>QuickStats:</i>Percentage* of Adults Aged 18–64 Years with Two or More Visits to the Emergency Department† in the Past 12 Months, by Health Insurance Coverage Status,§ and Race/Ethnicity¶ — National Health Interview Survey,** 2014

Health insurance coverage and healthcare expenditure pattern in rural Mysore

Abstract Background With increasing cost of health care and existing socioeconomic inequality in India, poor section of the society has not been able to avail quality medical care. Health insurance (HI) can take care of the poor but in India it is still not a felt need, especially in rural areas. Aims To know the coverage of HI in rural area of Mysore District and also to study the healthcare expenditure pattern in the area. Settings and design Community-based cross-sectional survey. Methods and material Calculated sample size of 300 households were covered in six villages selected by probability proportional to size sampling, in rural field practice area. Details of hospitalizations in previous 1-year duration were collected. HI coverage status and pattern of expenditure on health care were collected from head of the family with the aid of documents if available. Results HI coverage was 41% at household level and 33.9% (95% CI 31.5–36.3%) at individual level in the study area with maximum coverage by community-based HI schemes. Out of pocket expenditure was predominant (65%). Uninsured families had taken significantly higher debts compared to insured.

Effect of expanding medicaid for parents on children's health insurance coverage: lessons from the Oregon experiment.

In the United States, health insurance is not universal. Observational studies show an association between uninsured parents and children. This association persisted even after expansions in child-only public health insurance. Oregon's randomized Medicaid expansion for adults, known as the Oregon Experiment, created a rare opportunity to assess causality between parent and child coverage. To estimate the effect on a child's health insurance coverage status when (1) a parent randomly gains access to health insurance and (2) a parent obtains coverage. Oregon Experiment randomized natural experiment assessing the results of Oregon's 2008 Medicaid expansion. We used generalized estimating equation models to examine the longitudinal effect of a parent randomly selected to apply for Medicaid on their child's Medicaid or Children's Health Insurance Program (CHIP) coverage (intent-to-treat analyses). We used per-protocol analyses to understand the impact on children's coverage when a parent was randomly selected to apply for and obtained Medicaid. Participants included 14409 children aged 2 to 18 years whose parents participated in the Oregon Experiment. For intent-to-treat analyses, the date a parent was selected to apply for Medicaid was considered the date the child was exposed to the intervention. In per-protocol analyses, exposure was defined as whether a selected parent obtained Medicaid. Children's Medicaid or CHIP coverage, assessed monthly and in 6-month intervals relative to their parent's selection date. In the immediate period after selection, children whose parents were selected to apply significantly increased from 3830 (61.4%) to 4152 (66.6%) compared with a nonsignificant change from 5049 (61.8%) to 5044 (61.7%) for children whose parents were not selected to apply. Children whose parents were randomly selected to apply for Medicaid had 18% higher odds of being covered in the first 6 months after parent's selection compared with children whose parents were not selected (adjusted odds ratio [AOR]=1.18; 95% CI, 1.10-1.27). The effect remained significant during months 7 to 12 (AOR=1.11; 95% CI, 1.03-1.19); months 13 to 18 showed a positive but not significant effect (AOR=1.07; 95% CI, 0.99-1.14). Children whose parents were selected and obtained coverage had more than double the odds of having coverage compared with children whose parents were not selected and did not gain coverage (AOR=2.37; 95% CI, 2.14-2.64). Children's odds of having Medicaid or CHIP coverage increased when their parents were randomly selected to apply for Medicaid. Children whose parents were selected and subsequently obtained coverage benefited most. This study demonstrates a causal link between parents' access to Medicaid coverage and their children's coverage.

Psychological Distress and Health Insurance Coverage among Formerly Incarcerated Young Adults in the United States.

The United States incarcerates more people per capita than any other nation. Studies have consistently demonstrated higher prevalence of serious mental illness among the incarcerated. Although health care may be available to individuals while incarcerated, research is needed to understand the context of health care coverage and mental health after incarceration. The purpose of this study is to estimate the point prevalence of psychological distress (PD) among young adults with incarceration experience, while comparing the prevalence to that of young adults in the general population. Additionally, this study characterizes the relationship between incarceration experience and PD, while also examining this association given an individual's health insurance coverage status among young adults. Lastly, we examine if other individual, contextual, and behavioral factors influences the relationship between incarceration experience and PD, in addition to their health insurance coverage status. This study utilizes data from the 2008 panel of the National Longitudinal Survey of Youth 97, a population based survey dataset from the U.S. Department of Labor. Andersen's Behavioral Model of Health Services Use provided the conceptual framework for the study. The Mental Health Index 5 (MHI-5) was used to determine PD or normal mental health. Chi-square testing and multivariate logistic regression were performed to examine incarceration experience in association to PD. The sample with incarceration experience reported almost double the proportion of PD (21%) compared to those without an incarceration experience (11%). Young adults who have been incarcerated reported greater odds of PD than those with no incarceration experience (COR 2.18; 95% CI, 1.68–2.83) and the association was diminished in the presence of health insurance status and model covariates. Future health prevention and health management efforts should consider the impact of health insurance coverage status, health behaviors, and life satisfaction on mental health status among young adults with incarceration experience.

The Effects of Health Insurance Coverage on the Math Achievement Trajectories of School Children in Yuma County, Arizona: Implications for Education Accountability Policy

U.S. Federal and state education policies place considerable emphasis on assessing the effects that schools and teachers have on student test score performance. It is important for education policy makers to also consider other factors that can affect student achievement. This study finds that an exogenous school factor, discontinuous health insurance coverage, leads to a deficit in math achievement over time. A sample of Yuma County, Arizona public school students who experienced an illness or injury and whose health insurance coverage status was known were selected for inclusion into the study over five consecutive school years (1999 – 2003). The longitudinal math achievement trajectory of students who had private health insurance coverage was compared to students who had discontinuous coverage. Net of a student’s poverty status and other background characteristics the findings suggest that students who experienced a health event when they had no healthcare insurance had the same growth rate but lower overall math achievement. The average achievement gap was a constant -8.84 scale score points. However, separate analyses for specific types of illness/injury suggest the achievement deficit varied considerably and is typically larger.Other important findings from the study suggest that students who maintained continuous health insurance coverage through the SCHIP/Medicaid program had steeper, positive achievement gains than either those with private coverage or those who experience coverage gaps.

Lack of Health Insurance Increases All Cause and All Cancer Mortality in Adults: An Analysis of National Health and Nutrition Examination Survey (NHANES III) Data

Public use National Health and Nutrition Examination Survey (NHANES III) and NHANES III linked mortality data were here applied to investigate the association between health insurance coverage and all cause and all cancer mortality in adults. NHANES III household adult, laboratory and mortality data were merged. Only patients examined in the mobile examination center (MEC) were included in this study. The sampling weight employed was WTPFEX6, SDPPSU6 being used for the probability sampling unit and SDPSTRA6 to designate the strata for the survey analysis. All cause and all cancer mortalities were used as binary outcomes. The effect of health insurance coverage status on all cause and all cancer mortalities were analyzed with potential socioeconomic, behavioral and health status confounders. There were 2398 sample persons included in this study. The mean age was 40 years and the mean (S.E.) follow up was 171.85 (3.12) person months from the MEC examination. For all cause mortality, the odds ratios (significant p-values) of the covariates were: age, 1.0095 (0.000); no health insurance coverage (using subjects with health insurance), 1.71 (0.092); black race (using non-Hispanic white subjects as the reference group) 1.43, (0.083); Mexican-Americans, 0.60 (0.089); DMPPIR, 0.82, (0.000); and drinking hard liquor, 1.014 (0.007). For all cancer mortality, the odds ratio (significant p-values) of the covariates were: age, 1.0072 (0.00); no health insurance coverage, using with health coverage as the reference group, 2.91 (0.002); black race, using non-Hispanic whites as the reference group, 1.64 (0.047); Mexican Americans, 0.33 (0.008) and smoking, 1.017 (0.118). There was a 70% increase in risk of all cause death and almost 300% of all cancer death for people without any health insurance coverage.

Chronic Diseases, Self-Rated Health Status, Health Care Utilization and Health Insurance Status of Males in a Caribbean nation

Previous research which has examined men’s health have not coalesced in a single study chronic illness, self-rated health status, health care seeking behaviour, health insurance coverage and income function. The current study seeks to evaluate the general health status of males and association between chronic illness and particular socioeconomic factors, and model socioeconomic and other determinants of (1) chronic diseases; (2) self-rated health status; (3) health care utilization; (4) health insurance coverage status and (3) income. A total of 3,303 males were extracted from the 2007 Jamaica Survey of Living Conditions (JSLC). The JSLC is an annual cross-sectional probability sample survey which began in 1988. It is a modification of the World Bank’s Living Standard Household Survey. Stepwise logistic and multiple regressions were utilize to establish socioeconomic and other factors which are associated with the particular dependent variable. The prevalence of illness was 12.1% (chronic illness 33%; hypertension, 17.0%; diabetes mellitus, 9.1%). Almost 62% of those with chronic illness visited a health care practitioner in the last 4-weeks; and 72% were 60+ years. The mean age of male who had chronic illness was 66.2 years (SD = 14.2) compared to 31.0 years (27.9) for those with acute conditions. More males in the upper income strata had chronic illness (47.8%) compared to those in the lower socioeconomic strata (34.5%). Two variables emerged as significantly associated with chronic illness (age – OR = 1.03, 95% CI = 1.01 – 1.05; married respondents – OR = 3.32, 95% CI = 1.58 – 6.99). The findings provide valuable information that are critical to the understanding of male’s health and how these can be used to guide policy formulation and future research on men’s health.

A Comparison of Nonfatal Unintentional Injuries in the United States Among U.S.-Born and Foreign-Born Persons

The objective of this research was to compare the risk of nonfatal unintentional injuries between foreign-born and U.S.-born persons. Cross-sectional, nationally representative data were used from the 2000-2003 National Health Interview Survey to compare the risk of injury between 62,267 foreign-born and 322,200 U.S.-born persons. Nonfatal unintentional injuries occurring during the three months prior to the interview were compared by age, gender, education, poverty status, region of residence, family size, and health insurance coverage status. There were a total of 7,654 injured persons with U.S.-born persons having a weighted injury prevalence of 2.3% (95% confidence interval [CI]: 2.2, 2.4) and foreign-born persons having a weighted injury prevalence of 1.2% (95% CI: 1.0, 1.3). With the U.S.-born population as the reference and while controlling for sociodemographic characteristics, the odds ratio of injury risk was 0.54 (95% CI: 0.48, 0.62) for the foreign-born population. Transportation-related injuries occurred more frequently among foreign-born persons than among U.S.-born persons (23.7%, 95% CI: 19.7, 28.3 vs. 15.0%, 95% CI: 14.0, 16.2, respectively). This research is the first step in determining the morbidity from unintentional injuries among the foreign-born population in the U.S.

Adolescents’ Knowledge of Their Health Insurance Coverage

Purpose: To determine the accuracy of adolescents’ self-report of health insurance coverage, using parents’ report as a comparison standard. Methods: Two separate samples of urban, school-based adolescents and their parents completed self-administered questionnaires about type of health insurance coverage. Sample 1 included 123 and Sample 2 included 93 adolescent–parent pairs. Percent agreement and the kappa statistic were determined for each of the sample groups, and for males versus females and older (>14 years) versus younger (≤14 years) adolescents. Results: In Sample 1, 33% of adolescent respondents responded “don’t know” to the question about type of insurance coverage, and 4% left the question blank; in Sample 2, 3% answered “don’t know,” with none leaving the question blank. For Sample 1, we found a 57% rate of agreement of adolescents with their parents, and a corresponding kappa of .21. Females and older subjects demonstrated greater accuracy, with kappa’s all in the range .13–.29. In Sample 2, 73% of subjects agreed with parents’ report, with a kappa of .48. Females and older subjects also demonstrated greater accuracy, with the highest kappa of .59 demonstrated by older females. Excluding those responding with “don’t know,” we found overall percent agreement with parents of 87% in Sample 1 and 73% in Sample 2; the corresponding kappas were .47 and .51. Females demonstrated higher agreement with parents in both samples. The results stratifying by age were inconsistent. In Sample 1, privately insured subjects were more accurate reporters than those either on medical assistance or uninsured. In Sample 2, no differences were seen by type of insurance. Conclusions: Many adolescents do not know their health insurance coverage status. However, for those who did claim to know, acceptable rates of accuracy using both percent agreement and the kappa statistic were demonstrated. Further research is needed to determine how information about insurance is communicated to adolescents and how this knowledge affects access to and use of health services.