17,000 Child Deaths Linked To Lack Of Insurance

Kids without coverage are more apt to die while hospitalized, study finds
U.S. News & World Report

An estimated 17,000 children in the United States might have died unnecessarily over nearly two decades because they didn't have health insurance, according to a report from researchers at Johns Hopkins Children's Center in Baltimore.

They found that kids who lacked health insurance were 60 percent more likely to die in the hospital than were kids who had insurance. After adjusting for such differences as race and gender, uninsured kids were still 37.8 percent more likely to die than kids with insurance coverage.

David C. Chang, co-director of the pediatric surgery outcomes research group at Hopkins and a study co-author, said he could not think of a medical treatment that has such a dramatic impact on health outcomes as health insurance seemingly does.

"This is actually something we as a society ... can choose to do something about," he said. "It's literally with the stroke of somebody's pen, this could be changed."

The article was published online Oct. 30 in the Journal of Public Health.

Bruce Lesley, president of First Focus, a bipartisan child and family advocacy group, noted that data from the U.S. Institute of Medicine have shown that people who are uninsured have a higher mortality rate.

"You knew that it existed, you knew that there were cases [of child deaths related to lack of insurance], but I think this data is pretty shocking and really points to the need for national health reform," Lesley said.

In one of his first acts after taking office in January, President Barack Obama signed legislation reauthorizing the Children's Health Insurance Program (CHIP). The measure also provided funding for states to add several million more children to the rolls though 2013.

"CHIP has really worked and been very important and insures about 7 million kids in the country," Lesley said. Still, he said, roughly 6.5 million children who are eligible for Medicaid or CHIP remain uninsured -- for whatever reason.

Enrollment barriers are part of the problem, explained Lesley, whose organization endorses legislative proposals to move toward a "default enrollment" system. "The presumption should be the kid's enrolled, and let's figure out what program they're in," he said.

The Johns Hopkins team looked at the relationship between insurance status and kids' mortality to better inform the CHIP debate.

Using records from two large databases, lead author Dr. Fizan Abdullah, Chang and colleagues examined more than 23 million hospitalizations of people younger than 18.

Over an 18-year period though 2005, 117 million children were hospitalized - in standard and children's hospitals. Nearly 6 million kids were uninsured at the time of admission. In all, 38,649 children died while hospitalized.

Uninsured kids were 1.6 times more likely to die than children who had insurance.

Assuming that the insured and uninsured populations are identical, the difference in risk of mortality was 60 percent. The authors' actual predicted mortality is lower, however, because factors such as age, race and gender are associated with risks that affect outcomes, Chang explained.

"The 60 percent is the theoretical difference, and the 37 percent is the actual difference that you see in real life," he said. "Our extrapolation is based on that more conservative number."

The study includes some data from the period before CHIP was enacted in 1997. Though fewer kids are uninsured today than two decades ago, Chang said, that would not skew the risk of death from lack of insurance.

And though the study does not prove that being uninsured boosts a child's mortality risk, it does suggest a strong association between insurance status and odds of dying.

"I think the message is insurance is a choice we can make as a society, and this is something that we should consider," Chang said.