A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults

BACKGROUND: No recent national studies have assessed chronic illness prevalence or access to care among persons without insurance in the United States. OBJECTIVE: To compare reports of chronic conditions and access to care among U.S. adults, by self-reported insurance status. DESIGN: Population-based survey. SETTING: National Health and Nutritional Examination Survey (1999-2004). PARTICIPANTS: 12,486 patients age 18 to 64 years. MEASUREMENTS: Estimates of national rates of cardiovascular disease, hypertension, diabetes, hypercholesterolemia, active asthma or chronic obstructive pulmonary disease, previous cancer, and measures of access to care. RESULTS: On the basis of National Health and Nutrition Examination Survey (1999-2004) responses, an estimated 11.4 million (95% CI, 9.8 million to 13.0 million) working-age Americans with chronic conditions were uninsured, including 16.1% (CI, 12.6% to 19.6%) of the 7.8 million with cardiovascular disease, 15.5% (CI, 13.4% to 17.6%) of the 38.2 million with hypertension, and 16.6% (CI, 13.2% to 20.0%) of the 8.5 million with diabetes. After the authors controlled for age, sex, and race or ethnicity, chronically ill patients without insurance were more likely than those with coverage to have not visited a health professional (22.6% vs. 6.2%) and to not have a standard site for care (26.1% vs. 6.2%) but more likely to identify their standard site for care as an emergency department (7.1% vs. 1.1%) (P <0.001 for all comparisons). LIMITATION: The study was cross-sectional and used self-reported insurance and disease status. CONCLUSION: Millions of U.S. working-age adults with chronic conditions do not have insurance and have poorer access to medical care than their insured counterparts.