Health insurance status and injury mortality

In 2006, 20% of deaths among people 18-64 years were due to an external cause. Studies based on administrative data from the health care setting have shown that those lacking private health insurance at the time of injury have a higher risk of injury mortality compared with the privately insured. Using the 1997-2004 National Health Interview Survey (NHIS) and the recently released 1997-2006 NHIS Linked Mortality Files, we studied the association between health insurance status at interview (i.e. privately insured and uninsured) and injury mortality within four years of interview among those ages 18-60 years at interview. Injury mortality rates by insurance status were calculated within sociodemographic subgroups. Cox proportional hazards models were used to assess the association between insurance status and injury mortality, while controlling for known injury mortality risk factors. Results showed that the uninsured had higher injury mortality rates than the privately insured in all age, sex, race/ethnicity, education and poverty status subgroups. Cox models showed that after adjusting for age, sex and poverty status, uninsured persons were more likely to die from injury compared with privately insured persons (hazard ratio 1.64, 95% CI 1.34-2.01). After including reported health status in the model, there was a non-significant decrease in the hazard. Similar hazard ratios were observed (hazard ratio 1.53, 95% CI 1.24-1.88) after adding race/ethnicity and education in the model. A limitation of these results is that, unlike the trauma center based studies, we were unable to control for injury severity.