@article {7098, title = {Changes in health for the uninsured after reaching age-eligibility for Medicare.}, journal = {J Gen Intern Med}, volume = {21}, year = {2006}, month = {2006 Nov}, pages = {1144-9}, publisher = {21}, abstract = {

BACKGROUND: Uninsured adults in late middle age are more likely to have a health decline than individuals with private insurance.

OBJECTIVE: To determine how health and the risk of future adverse health outcomes changes after the uninsured gain Medicare.

DESIGN: Prospective cohort study.

PARTICIPANTS: Participants (N=3,419) in the Health and Retirement Study who transitioned from private insurance or being uninsured to having Medicare coverage at the 1996, 1998, 2000, or 2002 interview.

MEASUREMENTS: We analyzed risk-adjusted changes in self-reported overall health and physical functioning during the transition period to Medicare (t(-2) to t(0)) and the following 2 years (t(0) to t(2)).

RESULTS: Between the interview before age 65 (t(-2)) and the first interview after reaching age 65 (t(0)), previously uninsured individuals were more likely than those who had private insurance to have a major decline in overall health (adjusted relative risk [ARR] 1.46; 95\% confidence interval [CI] 1.03 to 2.04) and to develop a new physical difficulty affecting mobility (ARR 1.24; 95\% CI 0.96 to 1.56) or agility (ARR 1.33; 95\% CI 1.12 to 1.54). Rates of improvement were similar between the 2 groups. During the next 2 years (t(0) to t(2)), adjusted rates of declines in overall health and physical functioning were similar for individuals who were uninsured and those who had private insurance before gaining Medicare.

CONCLUSIONS: Gaining Medicare does not lead to immediate health benefits for individuals who were uninsured before age 65. However, after 2 or more years of continuous coverage, the uninsured no longer have a higher risk of adverse health outcomes.

}, keywords = {Age Factors, Aged, Cohort Studies, Eligibility Determination, Female, Health Status, Humans, Male, Medically Uninsured, Medicare, Middle Aged, Prospective Studies, United States}, issn = {1525-1497}, doi = {10.1111/j.1525-1497.2006.00576.x}, author = {David W. Baker and Joseph Feinglass and Durazo-Arvizu, Ramon and Whitney P. Witt and Joseph J Sudano and Jason A. Thompson} } @article {7073, title = {Health Insurance Coverage and the Risk of Decline in Overall Health and Death Among the Near Elderly, 1992-2002}, journal = {Medical Care}, volume = {44}, year = {2006}, note = {Article English}, pages = {277 -282}, publisher = {44}, abstract = {Background: Although individuals{\textquoteright} health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time. . Objective: We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death from 1992 to 2002, accounting for changes in self-reported overall health and insurance coverage. .Methods: We analyzed data from the Health and Retirement study, a prospective cohort study of a national sample of community-dwelling adults age 51-61 years old at baseline. Major decline in self-reported overall health and mortality was determined at 2-year intervals. . Results: People who were uninsured at baseline had a 35 (95 confidence interval CI 12-62 ) higher risk-adjusted mortality from 1992 to 2002 compared with those with private insurance. However, when we analyzed outcomes over 2-year intervals, individuals who were uninsured at the start of each interval were more likely to have a major decline in their overall health (pooled adjusted relative risk 1.43, 95 CI 1.28-1.63), but they were equally likely to die (pooled adjusted relative risk 0.96, 95 CI 0.73-1.27). Of the 1512 people who were uninsured at baseline, 220 (14.6 ) died; of those who died, only 70 (31.8 ) were still uninsured at the HRS inter-view prior to death. Conclusions: Death does not appear to be a short-term consequence of being uninsured. Instead, higher long-term mortality among the uninsured results from erosion in this population{\textquoteright}s health status over time and the attendant higher mortality associated with this. Most deaths among the uninsured occur after individuals have gained either public or private health insurance.}, keywords = {Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Methodology, Other}, author = {David W. Baker and Joseph J Sudano and Durazo-Arvizu, Ramon and Joseph Feinglass and Whitney P. Witt and Jason A. Thompson} } @article {7037, title = {Effect of Physical Activity on Functional Status among Older Middle-Age Adults with Arthritis}, journal = {Arthritis Care and Research}, volume = {53}, year = {2005}, pages = {879-85}, publisher = {53}, abstract = {Objective. To determine the effect of leisure time and work-related physical activity on changes in physical functioning among 3,554 nationally representative survey respondents, ages 53 63 years in 1994, with arthritis and joint symptoms, interviewed in the Health and Retirement Study (HRS). Methods. In 1992 1994, light and vigorous exercise items were empirically categorized into recommended, insufficient, and inactive leisure time physical activity levels using data from the HRS. Leisure and work-related physical activity levels in 1994 were used to predict 1996 functional decline or improvement, controlling for baseline functional difficulties, health status, sociodemographic characteristics, and behavioral risk factors. Results. Whereas 29.7 of respondents reported functional declines in 1996, 38.6 of those with baseline difficulties in 1994 reported improvement. Compared with inactive respondents, recommended and insufficient leisure time physical activity were equally protective against functional decline (odds ratio OR 0.59 and 0.62, respectively; P 0.0001). Higher levels of physical activity were also modestly associated with functional improvement among respondents with baseline functional difficulties (OR 1.47, P 0.05 and OR 1.45, P 0.01, respectively). Work-related physical activity was not a significant predictor of decline or improvement. Conclusion. Given the high prevalence of arthritis, even modest increases in rates of lifestyle physical activity among older adults could make a substantial contribution to disability-free life expectancy.}, keywords = {Health Conditions and Status}, url = {http://www.rheumatology.org/publications/acr/index.asp}, author = {Joseph Feinglass and Jason A. Thompson and Xiaoxing He and Whitney P. Witt and Rowland W Chang and David W. Baker} }