@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} }