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Accordingly, X (the number of deaths if everyone in this age group had insur- ance) was 40,548 divided by 1.05, or 38,617. The number of deaths resulting from uninsurance was the actual number of deaths (40,548) minus the number of deaths that would have resulted without any uninsured (38,617), or 1,930. 1

approximately 18,000 deaths resulted from uninsurance in 2000 (table 1).

Applying the IOM meth- odology to more recent Census estimates of the number of uninsured

number of uninsured yields an estimate that 137,000 adults age 25–64 died because of uninsurance from 2000 through 2006, including 22,000 people in 2006 (table 2). This represents an average of one death every 24 minutes.

An alternative calculation

Pursuing that same analysis with each 10-year age cohort, IOM concluded that

A p p l y i n g t h e I O M s m e t h o d o l o g y t o t h e m o s t r e c e n t C e n s u s B u r e a u e s t i m a t e s o f t h e a n n u a l

Age

U.S. population (millions)

Percent uninsured within age

Total deaths

Uninsured excess deaths

25–34 35–44 45–54 55–64 Total

37,440 44,780 38,040 23,784 144,044

group 21% 15% 12% 14% 16%

40,548 89,202 162,545 243,049 535,344

1,930 3,431 4,734 8,219 18,314

TABle 1. IOM estimates of the number of deaths resulting from uninsurance among adults age 25–64: 2000

T he IOM analysis may have under- estimated the number of deaths resulting from uninsurance. The underlying longitudinal studies on which IOM relied did not specify the impact of insurance coverage on mortality by 10-year age groups. Rather, they doc- umented the relationship between insurance and mortality across the sum t o t a l o f a l l s u r v e y e d a g e g r o u p s . 2 T h IOM’s methodology implicitly assumed that insurance reduces mortality by the identical percentage for each 10-year age band, which the underlying research did not show. More grounded in the research would be an application of differen- tial mortality estimates to all adults age 25–64, as was done for those longitudinal e

Source: IOM (2002).

TABle 2. Estimated number of deaths resulting from uninsurance among adults age 25–64, applying the IOM methodology to the Census Bureau’s most recent insurance totals: 2000–06

TABle 3. Using an alternative calculation, estimated number of deaths resulting from uninsurance among adults age 25–64: 2000–06

2000

146.1

15.5%

536,000

, 17 000

2001

21,000

2001

147.8

16.1%

549,000

18,000

2002

23,000

2002

150.3

17.1%

563,000

19,000

2003

24,000

2003

151.5

17.7%

572,000

20,000

2004

24,000

2004

153.4

17.6%

571,000

20,000

2005

25,000

2005

155.6

18.1%

589,000

21,000

2006

27,000

2006

157.7

18.7%

602,000

22,000

Total:

165,000

Total

137,000

Sources: March Current Population Surve , 2001–07; National Center for Health Statistics, final death rates for 2000–04 and preliminary death rates for 2005. Calculations shown in appendix.

Sources: March Current Population Surve , 2001–07; National Center for Health Statistics, final death rates for 2000–04 and preliminary death rates for 2005.

Population age

Percent

25–64 (millions)

uninsured

Total deaths

Uninsured

Year

excess deaths

2000

Year

Excess deaths due to uninsurance

20,000

Notes: Numbers are rounded to the nearest 1,000. otals may not add correctly because of rounding. This table s estimate for uninsured excess deaths in 2000 is slightly lower than the total published by the IOM because this table reflects the Census Bureau s downward adjustment of the number of uninsured from 2000 through 2005. In addition, the estimates in this table are based on estimates of the civilian population, and the IOM numbers included active-duty military; this table s estimates are based on weights derived from the 2000 Census, rather than the 1990 Census; and the table s estimates incorporate the NCHS s final death rate estimates for 2000, rather than the estimates for 1999 used by IOM.

Notes: Numbers are rounded to the nearest 1,000. otals may not add correctly because of rounding. This table displays the results of calculations that modify the IOM methodology by estimating excess deaths for 25–64-year-olds as a whole rather than for each 10-year age cohort among 25–64-year-olds.

Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality

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