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NEWS FROM
CAMBRIDGE HEALTH ALLIANCE
October 20, 2009
Illness Often Undiscovered and Undertreated Among the Uninsured
New study indicates gaps in care for diabetes, cholesterol, hypertension
Cambridge, MA…A new study shows uninsured American adults
with chronic illnesses like diabetes or high cholesterol often go
undiagnosed and undertreated, leading to an increased risk of costly,
disabling, and even lethal complications of their disease.
The study, published online today in Health Affairs, analyzed
data from a recent national survey conducted by the Centers for
Disease Control and Prevention (CDC). The researchers, based at
Harvard Medical School and Cambridge Health Alliance, analyzed data
on 15,976 U.S. non-elderly adults from the National Health and Nutrition
Examination Survey (NHANES), a CDC program, between 1999 and 2006.
Respondents answered detailed questions about their health and
economic circumstances. Then doctors examined them and ordered laboratory
tests.
The study found that about half of all uninsured people with diabetes
(46 percent) or high cholesterol (52 percent) did not know they
had these diseases. In contrast, about one-quarter of those with
insurance were unaware of their illnesses (23 percent for diabetes,
29.9 percent for high cholesterol).
Undertreatment of disease followed similar patterns, with the uninsured
being more likely to be undertreated than their insured counterparts:
58.3 percent vs. 51.4 percent had their high blood pressure poorly
controlled, and 77.5 percent vs. 60.4 percent had their high cholesterol
inadequately treated.
Surprisingly, being insured was not associated with a widely used
measure of diabetes control (a hemoglobin A1c level below 7), a
finding the authors attribute to the stringent definition of good
diabetes control used in the NHANES survey. Even with excellent
medical care, many diabetics fail to achieve such low hemoglobin
A1c levels. Using less stringent hemoglobin A1c thresholds of 8
and 9, uninsured adults had significantly worse blood sugar control
than their insured counterparts, the researchers found.
Lead author Dr. Andrew Wilper, who currently teaches at the University
of Washington School of Medicine, said: "Our study should lay
to rest the myth that the uninsured can get the care they need.
Millions have serious chronic conditions and don't even know it.
And they're not getting care that would prevent strokes, heart attacks,
amputations, and kidney failure."
Referring to a study released in the American Journal of Public
Health last month, which has been widely quoted by Sen. Max Baucus
and others, he added: "Our previous work demonstrated 45,000
deaths annually are linked to lack of health insurance. Our new
findings suggest a mechanism for this increased risk of death among
the uninsured. They're not getting life-saving care."
Dr. Steffie Woolhandler, professor of medicine at Harvard Medical
School, primary care physician at Cambridge Health Alliance, and
study co-author, said: "The uninsured suffer the most, but
even Americans with insurance have shocking rates of undertreatment,
in part because high co-payments and deductibles often make care
and medications unaffordable. We need to upgrade coverage for the
insured, as well as covering the uninsured."
Dr. David Himmelstein, associate professor of medicine at Harvard
Medical School, primary care physician at Cambridge Health Alliance,
and study co-author, said: "The Senate Finance Committee's
bill would leave 25 million Americans uninsured and unable to get
the ongoing, routine care that could save their lives and prevent
disability. No other wealthy nation tolerates this, yet Congress
is turning its back on tens of millions of Americans."
"Hypertension, diabetes, and elevated cholesterol among insured
and uninsured U.S. adults." Health Affairs, e-publication
on October, 20, 2009. Authors: Andrew P. Wilper, MD, MPH, Steffie
Woolhandler, MD, MPH, Karen E. Lasser, MD, MPH, Danny McCormick,
MD, MPH, David H. Bor, MD, and David U. Himmelstein, MD.
Cambridge Health Alliance is an innovative, award-winning
health system that provides high quality care in Cambridge, Somerville,
and Boston's metro-north communities. It includes three hospital
campuses, a network of primary care and specialty practices, the
Cambridge Public Health Dept., and the Network Health plan. CHA
is a Harvard Medical School teaching affiliate and is also affiliated
with Harvard School of Public Health, Harvard School of Dental Medicine,
and Tufts University School of Medicine. Visit us online at www.challiance.org.
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Media Contact
David Cecere
Cambridge Health Alliance
Phone: 617-503-8428
Cell: 617-921-9613
dcecere@challiance.org
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