A new US study concluded that lack of health insurance may have contributed or led to nearly 17,000 hospital deaths among American children over two decades.

The study was the work of lead researcher Dr Fizan Abdullah, pediatric surgeon at Johns Hopkins Children’s Center in Baltimore, Maryland, and colleagues and is due to be published on 30 October in the Journal of Public Health.

Abdullah and colleagues said that their study, which was funded by the Robert Garrett Fund for the Treatment of Children, is one of the largest ever to examine the effect of insurance on preventable deaths and potentially saveable lives of sick children in the US.

He and his colleagues reviewed over 23 million hospital records from 37 states covering the period 1988 to 2005 and compared the risk of death between hospitalized children with and without health insurance.

The results showed that 0.47 per cent (104,520) of 22.2 million insured hospitalized children died compared with 0.75 per cent (9,468) of 1.2 million uninsured hospitalized children.

After adjusting for potential confounders, they calculated that an uninsured child in the study was 60 per cent more likely to die in the hospital than an insured child.

Even when they compared rates of death by underlying disease, he and his colleagues found the uninsured still had a bigger risk of dying than the insured.

Abdullah told the media that:

“If you are a child without insurance, if you’re seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next room who has insurance.”

To establish what proportion of the uninsured child deaths would have been prevented had the children been insured, Abdullah and colleagues carried out a statistical simulation that projected the anticipated number of deaths for insured patients based on the severity of their illness (among other factors), and then applied this figure to the uninsured group.

The result showed that in the uninsured group there were 3,535 deaths that could not be explained by disease severity or other factors. Applying this proportionally to the total number of children in the US who were hospitalized during the period of the study (117 million), the researchers calculated an excess of 16,787 deaths among the nearly 6 million uninsured hospitalized children.

The researchers stressed that the findings only cover children who died while still in hospital and do not reflect rates of death after discharge. Neither did they include children who died without ever attending a hospital, they added, suggesting that in fact this meant the real death toll of uninsured children could be higher.

They also warned that the study only looked at records that were made after the deaths occurred, so it does not prove that lack of insurance raises the risk of dying, only that they are linked. However, because of the large volume of records, and the fact they managed to identify and eliminate the effect of many of the confounders, they said they were confident that their analysis showed a very strong link between health insurance and risk of dying.

As co-researcher Dr David Chang, also from Johns Hopkins Children’s Center, said:

“Can we say with absolute certainty that 17,000 children would have been saved if they had health insurance? Of course not.”

“The point here is that a substantial number of children may be saved by health coverage,” he added, explaining that:

“From a scientific perspective, we are confident in our finding that thousands of children likely did die because they lacked insurance or because of factors directly related to lack of insurance.”

More than 7 million children are uninsured in the US, and this study should help focus the mind not only of society as a whole but of all policy makers concerned with healthcare reform, said the researchers.

Co-author Dr Peter Pronovost, director of Critical Care Medicine at Johns Hopkins and medical director of the Center for Innovations in Quality Patient Care, said thousands of children die needlessly because they lack health insurance.

“In a country as wealthy as ours, the need to provide health insurance to the millions of children who lack it is a moral, not an economic issue,” said Pronovost.

Source: Johns Hopkins Children’s Center.

Written by: Catharine Paddock, PhD