Background
Lack of insurance is a barrier to optimal stroke risk factor control but data on its
long-term impact on stroke outcomes are sparse. We assessed the association between
health insurance and long-term mortality after stroke.
Methods
Using data from the National Health and Nutrition Examination Surveys 1999-2004 with
follow-up mortality assessment through 2006, we examined the independent effect of
health insurance on (1) stroke mortality among all adult participants (n = 15,049)
and (2) vascular and all-cause mortality rates among participants with self-reported
stroke (n = 563).
Results
Among individuals without a previous stroke, uninsured individuals aged less than
65 years were more likely to die of stroke than those with insurance (adjusted hazard
ratio [HR], 3.13; 95% confidence interval [CI], .96-10.23); however, among those aged
65 years or older, those with private insurance, private plus Medicare, or Medicare
plus Medicaid had similar risk of stroke mortality when compared to those with Medicare
alone. Stroke survivors aged 65 years or older with private insurance were less likely
to die from vascular causes (adjusted HR, .38; 95% CI, .23-.63) compared to those
with Medicare alone. For stroke survivors aged less than 65 years, uninsured individuals
had similar all-cause mortality rates compared to their counterparts with insurance.
Conclusions
Insurance status influences risk of dying from a stroke in the general population,
as well as long-term mortality rates among stroke survivors in the United States,
but these relationships vary by age.
Key Words
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Article info
Publication history
Published online: June 04, 2015
Accepted:
May 6,
2015
Received in revised form:
March 1,
2015
Received:
August 29,
2014
Footnotes
This study was supported by American Heart Association National Scientist Development Award.
The authors declare that they have no conflicts of interest and have nothing to disclose.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.05.007
Copyright
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
