Does health insurance impact long-term health outcomes after trauma? Results from a longitudinal study of a U.S. representative population

Purpose: To determine whether insurance status modifies the association between injuries and Health-Related Quality of Life (HRQOL) in a nationally representative sample of U.S. adults.

Design: This longitudinal study used the Medical Expenditure Panel Survey (MEPS). Individuals (N=50,225) were selected into the study were: at least 18 years old and completed the outcome assessment around the eighth-month of the second year of follow up. Injured individuals were those who reported an injury that was associated with at least one: hospitalization or a doctor visit in the first follow up year. HRQOL was evaluated using the Short Form 12 (SF-12) and Euroqol Health index (EQ-5D) measured in the second year of follow up. Also, healthcare utilization was examined among the study population by injury status and across insurance groups. For the multivariate analysis, a categorical variable including all injury-insurance combinations was created. Covariates included age, gender, education, race, diabetes, hypertension, and baseline self-reported health.

Results: 710 (1.4%) reported injuries. Multivariate analyses showed that injured individuals with public insurance had lower SF-12 [Physical Component scores (PCS)=8.5; Mental Component Score (MCS)=4.9)] than privately insured controls adjusting for other covariates, while uninsured had PCS and MCS that were respectively 2.6 and 4.1 lower than controls. Healthcare utilization among uninsured individuals was lower than the publically insured and private insurance holders.

Conclusions: We found injured individual to have lower HRQOL than those without injuries and this effect was exacerbated by insurance status. Our findings call for interventions aimed to narrow the outcome disparity among injured individuals.