Adverse Outcomes and Lack of Health Insurance among Newborns in an Eight-County Area of California, 1982 to 1986

Abstract

In this study of hospital discharge data on births to residents of an eight-county region of California, we found an increasing lack of health insurance that was associated with an elevated and increasing risk of adverse outcomes in newborns. Between 1982 and 1986, the percentage of newborns without health insurance increased overall by 45 percent (from 5.5 to 8.0 percent; P less than 0.001); the increases were larger among Asians (by 54 percent [from 7.8 to 12.0 percent]; P less than 0.001) and Latinos (by 140 percent [from 8.2 to 19.7 percent]; P less than 0.001). By 1986, the odds ratio for an adverse hospital outcome (defined as a prolonged hospital stay, transfer of the newborn to another institution, or death) was 1.31 (95 percent confidence interval, 1.17 to 1.46) in uninsured as compared with privately insured newborns, with control for race or ethnic group. There was a significant increase in risk over time (P less than 0.03); the comparable odds ratios in 1982 and 1984 were 1.11 (95 percent confidence interval, 0.93 to 1.33) and 1.19 (1.05 to 1.35), respectively. In 1986 the risks were especially elevated for uninsured as compared with privately insured blacks and Latinos (odds ratios, 2.24 [95 percent confidence interval, 1.60 to 3.13] and 1.56 [1.26 to 1.94], respectively); the increases in risk over time were the most marked in these groups. We believe that the elevated and increasing risks for uninsured newborns are explained at least in part by inadequate and diminishing access to care and that this burden is borne disproportionately by blacks and Latinos.

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

“…Low-income children are more likely to be uninsured, 22 and uninsured children are more likely than insured children to lack a usual source of health care, 11,23-26 delay care, 23,26 use less care, 26-30 receive poorer quality care, 31 and have poorer health. 7,11,32,33 Because minority children are disproportionately likely to be both low income and uninsured, their problems are compounded.Health system and individual factors both can contribute to ongoing racial/ethnic disparities, 8 yet their relative contributions to health disparities remain poorly understood. 34,35 Racial/ethnic disparities in health and medical care have been associated with health insurance, 36,37 sociodemographic factors, 38,39 and elements of the health care system such as accessibility and use of a medical home or usual source of care (USC).…”

“…Low-income children are more likely to be uninsured, 22 and uninsured children are more likely than insured children to lack a usual source of health care, 11,[23][24][25][26] delay care, 23,26 use less care, [26][27][28][29][30] receive poorer quality care, 31 and have poorer health. 7,11,32,33 Because minority children are disproportionately likely to be both low income and uninsured, their problems are compounded.…”

Factors That Influence Receipt of Recommended Preventive Pediatric Health and Dental Care

“…1 Uninsured children and poor children are less likely to have a usual source of care, more likely to go without needed medical care, and more likely to use fewer or no health services than their insured and higherincome counterparts. [2][3][4][5][6][7][8][9] Use of diagnostic and preventive dental care is highest among white and nonpoor children, 10 whereas adolescents who are uninsured, male, and nonwhite are least likely to have an annual dental visit. 2 Previous research also documents differences in access to care and insurance by age.…”

The effect of WIC and Medicaid on infant mortality in the United States.

“…Medicaid is important in promoting the use of medical services, including prenatal services, among low-income women.28 '29 Lack of insurance is associated with adverse infant outcomes. 30 We expect program participation to affect infant mortality depending on when participation occurs (during pregnancy or during the infant's first year) and on the cause of death. We distinguish endogenous and exogenous causes of infant death.…”