Changes in Characteristics of Chronically Uninsured Adults: Early Release of Estimates From the National Health Interview Survey, 2010–September 2016April 27, 2017
Questions for Emily P. Zammitti, M.P.H., Associate Service Fellow and Lead Author on “Changes in Characteristics of Chronically Uninsured Adults: Early Release of Estimates From the National Health Interview Survey, 2010–September 2016.”
Q: What do you mean by the “chronically uninsured?”
EZ: For the purposes of this report, persons were defined as chronically uninsured if they were uninsured at the time of interview and had lacked coverage for more than 1 year.
Q: What groups are more likely to be chronically uninsured?
EZ: We have to be careful about how we speak about the results of this report. The focus of this report is the population who are chronically uninsured. Therefore it does not address which groups are more likely to be chronically uninsured. Among the chronically uninsured, certain groups are larger than others. In the first 9 months of 2016, the proportion of chronically uninsured adults who lived in the South was larger than the proportion who lived in the Northeast, Midwest, or West regions. The proportion who were aged 45-64 was larger than the proportion who were aged 18-25, 26-34, and 35-44. The proportion who were Hispanic was larger than the proportion who were non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and non-Hispanic other race. The proportion who rated their health as excellent or very good was larger than the proportion who rated their health as either good or fair or poor. A major focus of this report is how these proportions have changed since 2010.
Q: How many of the chronically uninsured are younger people who in many cases are healthy vs. older people who are much more likely to need insurance?
EZ: In the first 9 months of 2016, we estimate that 16% of chronically uninsured adults aged 18-64 were aged 18-25, 25.2% were aged 26-34, 26.8% were aged 35-44, and 32% were aged 45-64. Since 2010, the proportion of chronically uninsured adults who were aged 18-25 has decreased, and the proportion who were aged 35-44 and 45-64 increased. For this report, we did not disaggregate health status by age.
Q: Are there more chronically uninsured people in states that did not expand Medicaid?
EZ: We did not look at the chronically uninsured population stratified by state Medicaid expansion status for this report. However, we do look at the percent who are uninsured at the time of interview, which includes both chronically and short-term uninsured, by state Medicaid expansion status in our quarterly Health Insurance Early Release report. The percentage who are uninsured is higher in states which have not expanded Medicaid, compared with states which have expanded Medicaid.
Q: What in this new analysis did you find most interesting?
EZ: The first figure in our report shows that since 2010, the percentage of adults aged 18-64 who are chronically uninsured has been cut by more than half from 16.8% in 2010 to 7.6% in the first 9 months of 2016.
Q: When will you have full-year numbers available for 2016?
EZ: Full year 2016 Early Release data will be available on May 17th, 2017 through the Research Data Centers. That’s also when the next Health Insurance Early Release report will come out. Full year final data are expected to be released at the end of June 2017, six months after the completion of data collection.
Q: What do you make of the finding that the percent of chronically uninsured who are unemployed has been dropping while the percent who are employed has been increasing?
EZ: We don’t propose potential explanations for the results of this report, that’s outside of the scope of our work, but we did see a decrease in the proportion of chronically uninsured adults aged 18-64 who were unemployed from 16.3% in 2010 to 10.1% in the first 9 months of 2016, with a corresponding increase in the proportion who were employed during this time period.
Q: Anything else you feel is noteworthy about your study?
EZ: lthough the majority of chronically uninsured adults rate their health as excellent or very good, this proportion has not changed significantly from 2010 to the first 9 months of 2016. This means that the chronically uninsured population aged 18-64 is not more or less healthy (according to their self-rated responses) in the first 9 months of 2016 than in 2010.
Questions for Ryne Paulose, NHANES’ Associate Director for Science and Lead Author of “Characteristics of Adults with Hypertension who are Unaware of their Hypertension, NHANES 2011–2014”
Q: What made you want to do a report on adults with hypertension who are unaware of their hypertension?
RP: We have a number of NCHS brief reports on prevalence of hypertension, awareness, control, and treatment. We wanted to publish a brief report that further characterizes adults who are unaware of their hypertension. Being undiagnosed and unaware of having hypertension is a problem since these blood pressure for these adults will remain above normal levels and have potentially damaging effects.
Q: It looks there was a major decline in the number of adults with hypertension that were unaware they had it since 1999-2002 data? Do you know why there has been a significant decline?
RP: Yes, there was a 46% decline from 1999-2002 to 2011-2014, in the percent of adults with hypertension who were unaware. The decline was seen across all age groups. But the decline was greater for those 60 years and older.
We did not specifically examine reasons for the decline in this brief report. But in our report, we do see that the percent unware was lower among adults with health insurance or with increased healthcare visits in the prior year. This implies that increased contact with a healthcare provider increases the chances that high blood pressure will be identified and diagnosed.
Q: Were there major differences in income and education level among adults with hypertension who were unaware of their hypertension?
RP: Generally, there were no differences by income or education level in the percent of adults with hypertension who were unaware. About 14-18% of adults at different income levels were unaware and about 14-19% of adults at different education levels were unaware.
Q: Was there anything in your report that surprised you?
RP: The oversampling of Asian Americans in NHANES is new as of 2011. So, the estimates for Non-Hispanic Asians was an unknown from earlier years. So, the differences we reported did surprise me. Further analysis is in progress to better understand these differences.
Q: What is the take home message from this report?
RP: Although we’ve seen a significant decline in the percent of adults with hypertension who were unaware of their hypertension, nearly 1 in 6 adults with hypertension is unaware of his/her hypertension. Additional efforts may be needed to identify and diagnose these individuals for management and control of their high blood pressure.
QuickStats: Number of Deaths from 10 Leading Causes by Sex — National Vital Statistics System, United States, 2015April 24, 2017
In 2015, a total of 1,339,226 deaths among females and 1,373,404 deaths among males occurred.
Heart disease and cancer were the top two causes of death for both females and males; other leading causes varied in rank by sex.
The 10 leading causes of death accounted for approximately three-quarters of all deaths.