@article {7156, title = {Baseline health, socioeconomic status, and 10-year mortality among older middle-aged Americans: findings from the Health and Retirement Study, 1992 2002.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Jul}, pages = {S209-17}, publisher = {62}, abstract = {

OBJECTIVE: This study analyzed whether socioeconomic status in older middle age continues to be associated with 10-year survival after data are controlled for baseline health status.

METHODS: We confirmed deaths through 2002 for 9,759 participants in the Health and Retirement Study, aged 51 to 61 in 1992. We used discrete time survival models to examine hazard ratios over 10 years of follow-up. We examined associations of demographic characteristics and socioeconomic status measures before and after adjustment by health status and behavioral risk factors.

RESULT: The 10-year mortality rate was 10.9\%, ranging from 4.7\% for respondents reporting excellent health to 35.8\% for those reporting poor health at baseline. Lower levels of education, income, and wealth were strongly associated with higher mortality risk after we controlled for just demographic characteristics. After further adjustment for health status and behavioral risk factors, only household income remained significant.

DISCUSSION: Baseline health by age 50 is an important pathway in the association between midlife socioeconomic status and mortality risk to age 70. The continuing effect of low household income on mortality risk was concentrated among respondents reporting excellent to good health at baseline. Socioeconomic disparities in middle-age health continue to limit disability-free life expectancy at older ages.

}, keywords = {Adult, Aged, Aged, 80 and over, Economics, Education, Follow-Up Studies, Health Status, Humans, Income, Middle Aged, Mortality, Motor Activity, Pilot Projects, Proportional Hazards Models, Retirement, Risk Factors, Risk-Taking, Smoking, Social Class, Thinness, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.4.s209}, author = {Joseph Feinglass and Lin, Suru and Jason A. Thompson and Joseph J Sudano and Dorothy D Dunlop and Song, Jing and David W. Baker} } @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 {7095, title = {The effect of private insurance on the health of older, working age adults: evidence from the health and retirement study.}, journal = {Health Serv Res}, volume = {41}, year = {2006}, month = {2006 Jun}, pages = {759-87}, publisher = {41}, abstract = {

OBJECTIVE: Primarily, to determine if the presence of private insurance leads to improved health status, as measured by a survey-based health score. Secondarily, to explore sensitivity of estimates to adjustments for endogeneity. The study focuses on adults in late middle age who are nearing entry into Medicare.

DATA SOURCES: The analysis file is drawn from the Health and Retirement Study, a national survey of relatively older adults in the labor force. The dependent variable, an index of 5 health outcome items, was obtained from the 1996 survey. Independent variables were obtained from the 1992 survey. State-level instrumental variables were obtained from the Area Resources File and the TAXSIM file. The final sample consists of 9,034 individuals of which 1,540 were uninsured.

STUDY DESIGN: Estimation addresses endogeneity of the insurance participation decision in health score regressions. In addition to ordinary least squares (OLS), two models are tested: an instrumental variables (IV) model, and a model with endogenous treatment effects due to Heckman (1978). Insurance participation and health behaviors enter with a lag to allow their effects to dissipate over time. Separate regressions were run for groupings of chronic conditions.

PRINCIPAL FINDINGS: The OLS model results in statistically significant albeit small effects of insurance on the computed health score, but the results may be downward biased. Adjusting for endogeneity using state-level instrumental variables yields up to a six-fold increase in the insurance effect. Results are consistent across IV and treatment effects models, and for major groupings of medical conditions. The insurance effect appears to be in the range of about 2-11 percent. There appear to be no significant differences in the insurance effect for subgroups with and without major chronic conditions.

CONCLUSIONS: Extending insurance coverage to working age adults may result in improved health. By conjecture, policies aimed at expanding coverage to this population may lead to improved health at retirement and entry to Medicare, potentially leading to savings. However, further research is needed to determine whether similar results are found when alternative measures of overall health or health scores are used. Future research should also explore the use of alternative instrumental variables. Preliminary results provide no justification for targeting certain subgroups with susceptibility to certain chronic conditions rather than broad policy interventions.

}, keywords = {Chronic disease, Data collection, Female, Health Status, Humans, Insurance, Health, Male, Medically Uninsured, Middle Aged, Private Sector, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2006.00513.x}, author = {Avi Dor and Joseph J Sudano and David W. Baker} } @article {7072, title = {Explaining US racial/ethnic disparities in health declines and mortality in late middle age: the roles of socioeconomic status, health behaviors, and health insurance.}, journal = {Soc Sci Med}, volume = {62}, year = {2006}, month = {2006 Feb}, pages = {909-22}, publisher = {62}, abstract = {

Pervasive health disparities continue to exist among racial/ethnic minority groups, but the factors related to these disparities have not been fully elucidated. We undertook this prospective cohort study to determine the independent contributions of socioeconomic status (SES), health behaviors, and health insurance in explaining racial/ethnic disparities in mortality and health declines. Our study period was 1992-1998, and our study population consists of a US nationally representative sample of 6286 non-Hispanic whites (W), 1391 non-Hispanic blacks (B), 405 Hispanics interviewed in English (H/E), and 318 Hispanics interviewed in Spanish (H/S), ages 51-61 in 1992 in the Health and Retirement Study. The main outcome measures were death; major decline in self-reported overall health (SROH); and combined outcome of death or major decline in SROH. Crude mortality rates over the 6-year study period for W, B, H/E and H/S were 5.8\%, 10.6\%, 5.8\%, and 4.4\%, respectively. Rates of major decline in SROH were 14.6\%, 23.2\%, 22.1\% and 39.4\%, for W, B, H/E and H/S, respectively. Higher mortality rates for B versus W were mostly explained by worse baseline health. For major decline in SROH, education, income, and net worth independently explained more of the disparities for all three minority groups as compared to health behaviors and insurance, reducing the effect for B and H/E to non-significance, while leaving a significant elevated odds ratio for H/S. Without addressing the as-yet undetermined and pernicious effects of lower SES, public health initiatives that promote changing individual health behaviors and increasing rates of insurance coverage among blacks and Hispanics will not eliminate racial/ethnic health disparities.

}, keywords = {Black or African American, Cohort Studies, Female, Health Behavior, Health Status Disparities, Hispanic or Latino, Humans, Insurance, Health, Logistic Models, Male, Medically Uninsured, Middle Aged, Mortality, Poverty, Risk Assessment, Social Class, Sociology, Medical, United States, White People}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2005.06.041}, author = {Joseph J Sudano and David W. Baker} } @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 {8754, title = {Differences in leisure-time, household, and work-related physical activity by race, ethnicity, and education}, journal = {Journal of General Internal Medicine}, volume = {20}, year = {2005}, month = {Jan-03-2005}, pages = {259 - 266}, abstract = {Background: Racial and ethnic minority groups have lower levels of leisure-time physical activity (LTPA) than whites, but it is unclear how much of this is explained by differences in socioeconomic status and health. Objective: To examine differences in LTPA, work-related physical activity (WRPA; heavy household chores and strenuous job activities), and total physical activity (TPA) by race, ethnicity, and education. Design, Setting, and Participants: Cross-sectional analyses of data from the 1992 Health and Retirement Study for a nationally representative cohort of 9,621 community-dwelling adults aged 51{\textendash}61 years. Measurements: Physical activity scores for LTPA, WRPA, and TPA based upon self-reported frequency of light or vigorous recreational activities, heavy household chores, and strenuous job-related physical activities. Main Results: LTPA was lower for blacks and Hispanics compared to whites, and LTPA steadily declined with lower levels of education. WRPA showed the reverse pattern, being lowest for whites and persons with greater education. Education was far more important than race/ethnicity as a determinant of LTPA and WRPA in multivariate analyses. After adjusting for differences in overall health and physical functioning, mean TPA scores were similar across racial/ethnic and education categories; blacks (β=1.0; 95\% confidence interval [CI], 0.5 to 1.5) and Spanish-speaking Hispanics (β=1.1; 95\% CI, 0.3 to 1.9) had slightly higher levels of TPA than whites (P<.01 and P=.01, respectively). Conclusions: Differences in educational attainment and health status accounted for virtually all of the racial and ethnic differences in LTPA. After accounting for WRPA, TPA was similar across race, ethnicity, and education subgroups.}, keywords = {Education, Leisure activities, Mortality, Older Adults, Physical activity, Racial/ethnic differences}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2005.40198.x}, url = {http://link.springer.com/10.1111/j.1525-1497.2005.40198.xhttp://www.springerlink.com/index/pdf/10.1111/j.1525-1497.2005.40198.x}, author = {Xiaoxing He and David W. Baker} } @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} } @article {7017, title = {Health insurance coverage during the years preceding medicare eligibility.}, journal = {Arch Intern Med}, volume = {165}, year = {2005}, month = {2005 Apr 11}, pages = {770-6}, publisher = {165}, abstract = {

BACKGROUND: Adults in late middle age who lack health insurance are more likely to die or experience a decline in their overall health. Because most estimates of the uninsured are cross-sectional, the true number of individuals whose health is at risk from being uninsured is unclear.

METHODS: We analyzed a nationally representative sample of 6065 US adults 51 to 57 years old who were interviewed in 1992, 1994, 1996, 1998, and 2000 as part of the Health and Retirement Study. Insurance coverage was determined at the time of each interview and classified as private, public, or uninsured. Longitudinal data were used to determine the proportion of individuals who were uninsured at any interview during the 8-year study period.

RESULTS: The proportion of participants who were uninsured at the time of the 1992, 1994, 1996, 1998, and 2000 interviews was 14.3\%, 10.8\%, 9.7\%, 8.8\%, and 8.2\%, respectively. People frequently transitioned between having insurance and being uninsured. As a result, despite the declining prevalence of being uninsured, the percentage who were uninsured at least once during the 8-year period rose to 23.3\% by 2000; few participants (2.6\%) were continuously uninsured. Only 60.1\% of participants were continuously enrolled in private insurance across all 5 interviews.

CONCLUSIONS: The proportion of US adults in late middle age at risk from being uninsured over a 10-year follow-up period was 2 to 3 times higher than cross-sectional estimates. At least one quarter of older adults will be uninsured at some point during the years preceding eligibility for Medicare.

}, keywords = {Age Factors, Black or African American, Cohort Studies, Female, Health Status, Hispanic or Latino, Humans, Insurance Coverage, Insurance, Health, Male, Medically Uninsured, Middle Aged, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0003-9926}, doi = {10.1001/archinte.165.7.770}, author = {David W. Baker and Joseph J Sudano} } @article {6963, title = {Body mass index, physical activity, and the risk of decline in overall health and physical functioning in late middle age.}, journal = {Am J Public Health}, volume = {94}, year = {2004}, month = {2004 Sep}, pages = {1567-73}, publisher = {94}, abstract = {

OBJECTIVES: We examined the relation between body mass index, exercise, overall health, and physical functioning.

METHODS: We studied 7867 adults aged 51 to 61 years in 1992 to 1996. Adjusted relative risks for health decline and new physical difficulties were determined with logistic regression.

RESULTS: Overweight and obesity were independently associated with health decline (adjusted relative risk [ARR] = 1.29 and 1.36) and development of a new physical difficulty (ARR = 1.27 and 1.45). Regular exercise significantly reduced the risk of health decline and development of a new physical difficulty, even among obese individuals.

CONCLUSIONS: Maintaining ideal body weight is important in preventing decline in overall health and physical functioning. However, regular exercise can reduce the risk of health decline even among individuals who cannot achieve ideal weight.

}, keywords = {Attitude to Health, Body Mass Index, Female, Health Status, Humans, Logistic Models, Male, Middle Aged, Motor Activity, Obesity, Quality of Life, Risk Assessment, Risk Factors, Risk Reduction Behavior, Self Care, United States}, issn = {0090-0036}, doi = {10.2105/ajph.94.9.1567}, author = {Xiaoxing He and David W. Baker} } @article {6962, title = {Changes in weight among a nationally representative cohort of adults aged 51 to 61, 1992 to 2000.}, journal = {Am J Prev Med}, volume = {27}, year = {2004}, month = {2004 Jul}, pages = {8-15}, publisher = {27}, abstract = {

BACKGROUND: Few studies have examined patterns and predictors of changes in body weight among adults in late middle age.

METHODS: Prospective cohort study of 7391 community-dwelling U.S. adults aged 51 to 61 years at baseline (1992), using publicly available data files from the 1992, 1994, 1996, 1998, and 2000 Health and Retirement Survey interviews. Changes in weight and body mass index (BMI) were examined for different racial/ethnic groups of men and women. The predictors of changes in body weight and BMI were determined using gender-specific linear regression.

RESULTS: Mean body weight and BMI increased in both genders and all ethnic groups. The mean weight gain was higher for women (1.67 kg, 95\% confidence interval [CI]=1.34-1.99) than for men (1.43 kg, 95\% CI=1.17-1.68). White men and women had the lowest baseline BMI but tended to gain more weight than other racial/ethnic groups. In multivariate analyses, individuals who were older or had higher baseline weight showed less weight gain. Men were less likely to gain weight if their self-reported overall health at baseline was poor compared to those in excellent health. Regular light or vigorous recreational activities and work-related activities were not associated with less weight gain. Race, education, and income were not associated with weight gain in multivariate analyses.

CONCLUSIONS: All population subgroups are at risk for weight gain. Public health messages should target diverse populations. The current levels of physical activity attained by this population do not appear to protect against weight gain.

}, keywords = {Body Mass Index, Body Weight, Female, Health Surveys, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Motor Activity, Multivariate Analysis, Prospective Studies, Racial Groups, Sex Factors, United States}, issn = {0749-3797}, doi = {10.1016/j.amepre.2004.03.016}, author = {Xiaoxing He and David W. Baker} } @article {5550, title = {The Effects of Private Insurance on Measures of Health: Evidence from the Health and Retirement Study}, year = {2003}, institution = {Cambridge, MA, National Bureau of Economic Research}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance}, url = {http://papers.nber.org/papers/W9774}, author = {Avi Dor and Joseph J Sudano and David W. Baker} } @article {6849, title = {Intermittent lack of health insurance coverage and use of preventive services.}, journal = {Am J Public Health}, volume = {93}, year = {2003}, month = {2003 Jan}, pages = {130-7}, publisher = {93}, abstract = {

OBJECTIVES: This study examined the association between intermittent lack of health insurance coverage and use of preventive health services.

METHODS: Analyses focused on longitudinal data on insurance status and preventive service use among a national sample of US adults who participated in the Health and Retirement Study.

RESULTS: Findings showed that, among individuals who obtain insurance coverage after histories of intermittent coverage, relatively long periods may be necessary to reestablish clinically appropriate care patterns. Increasing periods of noncoverage led to successively lower rates of use of most preventive services.

CONCLUSIONS: Intermittent lack of insurance coverage-even across a relatively long period-results in less use of preventive services. Studies that examine only current insurance status may underestimate the population at risk from being uninsured.

}, keywords = {Episode of Care, Female, Health Behavior, Health Status, Humans, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Outcome Assessment, Health Care, Patient Acceptance of Health Care, Preventive Health Services, Socioeconomic factors, United States}, issn = {0090-0036}, doi = {10.2105/ajph.93.1.130}, author = {Joseph J Sudano and David W. Baker} } @article {6828, title = {Loss of health insurance and the risk for a decline in self-reported health and physical functioning.}, journal = {Med Care}, volume = {40}, year = {2002}, month = {2002 Nov}, pages = {1126-31}, publisher = {40}, abstract = {

BACKGROUND: Millions of Americans are intermittently uninsured. The health consequences of this are not known.

SETTING: National survey.

PARTICIPANTS: Six thousand seventy-two participants in the Health and Retirement Study (HRS) age 51 to 61 years old with private insurance in 1992.

MEASUREMENTS: Loss of insurance coverage between 1992 and 1992 and development of a major decline in overall health or a new physical difficulty between 1994 and 1996.

RESULTS: In 1994, 5768 (95.0\%) people continued to have private insurance, 229 (3.8\%) reported having lost all insurance, and 75 (1.2\%) converted to having only public insurance. Over the subsequent 2 years (1994-1996), the risk for a major decline in overall health was 15.6\% for those who lost all insurance versus 7.2\% for those with continuous private insurance (P <0.001). After adjusting for baseline sociodemographics, health behaviors, and health status, the adjusted relative risk for a major decline in health for those who lost coverage was 1.82 (95\% CI, 1.25-2.59) compared with those with continuous private insurance. Those who lost insurance also had a higher risk for developing a new mobility difficulty compared with those with continuous private insurance (28.5\% vs. 20.4\%, respectively; P= 0.02), but this was not significant in multivariate analysis (adjusted RR, 1.26; 95\% CI, 0.90-1.68).

CONCLUSIONS: Loss of insurance has adverse health consequences even within 2 years after becoming uninsured. Studies of insurance coverage should routinely measure the number of Americans uninsured at any time over the preceding 2 years as a more accurate measure of the population at risk from being uninsured.

}, keywords = {Female, Health Services Accessibility, Health Status, Humans, Insurance, Health, Male, Medically Uninsured, Middle Aged, Regression Analysis, Risk, Self Efficacy}, issn = {0025-7079}, doi = {10.1097/00005650-200211000-00013}, author = {David W. Baker and Joseph J Sudano and Jeffrey M. Albert and Elaine A Borawski and Avi Dor} } @article {6744, title = {Antihypertensive Medication Use in Hispanic Adults: A comparison with Black adults and White adults}, journal = {Medical Care}, volume = {39}, year = {2001}, pages = {575-87.}, publisher = {39}, abstract = {BACKGROUND. Variations in awareness, treatment, and control of hypertension among different racial/ethnic groups have been widely reported. It is unclear whether these differences are explained fully by differences in socioeconomic status, insurance coverage, health status, and health behaviors, or whether these differences indicate that racial/ethnic subgroups have unique barriers to hypertension control. OBJECTIVES. Determine whether there are significant differences between racial/ethnic groups in medication use for hypertension after adjusting for potentially confounding variables. RESEARCH DESIGN. Cross-sectional analysis of the 1992 Health and Retirement Study. SUBJECTS. 2450 non-Hispanic white, 939 non-Hispanic black, and 345 Hispanic participants, ages 51 to 61, reporting a history of hypertension. MEASURES. Self-reported current antihypertensive medication use. We used logistic regression to adjust for demographics, socioeconomic status, health status, insurance, and health risk behaviors. RESULTS. 63.6 of white adults, 72.6 of black adults, and 52.5 of Hispanic adults reported current medication use to control hypertension (P 0.001 across all three groups). In stratified analysis, the lower rate of use for Hispanic adults was consistent regardless of gender, insurance coverage, or health status. After controlling for all variables, the adjusted prevalence for Hispanic adults was 50.8 and 73.3 for black adults. CONCLUSIONS. The differences in antihypertensive medication use between white adults, black adults, and Hispanic adults, particularly the markedly lower rates among Hispanic adults, are not explained by differences in demographics, socioeconomic status, health insurance coverage, health status, or health risk behaviors. Alternative explanations for these results and areas for future research and intervention are explored.}, keywords = {Demographics, Health Conditions and Status, Healthcare, Methodology, Risk Taking, Women and Minorities}, author = {Joseph J Sudano and David W. Baker} } @article {6736, title = {Lack of Health Insurance and Decline in Overall Health in Late Middle Age}, journal = {New England Journal of Medicine}, volume = {345}, year = {2001}, pages = {1106-12.}, publisher = {345}, abstract = {BACKGROUND: The number of adults in their 50s and 60s in the United States who do not have health insurance is increasing. This group may be particularly vulnerable to the ill effects of being uninsured. METHODS: We conducted a prospective cohort study using files from the Health and Retirement Study, a national survey of adults who were 51 to 61 years old in 1992. We determined the risks of a major decline in overall health and of the development of new physical difficulties between 1992 and 1996 for participants who were continuously uninsured (uninsured in 1992 and in 1994), those who were intermittently uninsured (uninsured either in 1992 or in 1994), and those who were continuously insured. We used logistic regression to determine the independent effects of being uninsured on health outcomes after adjustment for base-line sociodemographic factors, preexisting medical conditions, and types of health-related behavior such as smoking and alcohol use. RESULTS: We analyzed data for 7577 participants. The 717 continuously uninsured participants and the 825 intermittently uninsured participants were more likely than the 6035 continuously insured participants to have a major decline in overall health between 1992 and 1996 (21.6 percent, 16.1 percent, and 8.3 percent of the three groups, respectively; P 0.001 for both comparisons). According to a multivariate analysis, the adjusted relative risk of a major decline in overall health was 1.63 (95 percent confidence interval, 1.26 to 2.08) for continuously uninsured participants and 1.41 (95 percent confidence interval, 1.11 to 1.78) for intermittently uninsured participants, as compared with continuously insured participants. A new difficulty in walking or climbing stairs was also more likely to develop in the continuously or intermittently uninsured participants than in the continuously insured participants (28.8 percent, 26.4 percent, and 17.1 percent of the three groups, respectively; P 0.001 for both comparisons). The adjusted relative risk of such a new physical difficulty was 1.23 (95 percent confidence interval, 1.02 to 1.47) for the continuously uninsured participants and 1.26 (95 percent confidence interval, 1.01 to 1.54) for the intermittently uninsured participants. CONCLUSIONS: The lack of health insurance is associated with an increased risk of a decline in overall health among adults 51 to 61 years old.}, keywords = {Demographics, Health Conditions and Status, Medicare/Medicaid/Health Insurance, Methodology, Other}, doi = {10.1056/NEJMsa002887}, author = {David W. Baker and Joseph J Sudano and Jeffrey M. Albert and Elaine A Borawski and Avi Dor} }