Study finds lack of health insurance may be associated with increased rates of stroke

April 02, 2007

BOSTON - The lack of health insurance prompts people to forego routine physical exams and have a reduced awareness of cardiovascular risk factors and is associated with increased rates of stroke and death, researchers have concluded.

A study in the April issue of the Journal of the Society of General Internal Medicine found people without health insurance are more likely to forego routine physical exams and had a higher risk of being unaware of a personal diagnosis of high blood pressure, diabetes or high cholesterol levels - all risk factors for cardiovascular disease. Surprisingly, researchers say, the lack of health insurance did not translate into a higher risk for myocardial infarction, of heart attack.

"We speculate that this may relate to the relative importance of hypertension as a risk factor for stroke, says Angela Fowler-Brown, MD, MPH, the lead author, a physician in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and an Instructor of Medicine at Harvard Medical School.

"Hypertension is the most powerful risk factor for stroke, and in our study we found that hypertension was significantly less likely to be well controlled in those lacking insurance," she says. "While hypertension is also an important risk factor for myocardial infarction, other factors such as inflammation, cholesterol and inherited traits may of greater relative importance in the development of myocardial infarction than in stroke.

The prospective study of 15,792 participants in the Atherosclerosis Risk in Communities database also found that those who reported being uninsured at leas once were more often female and non-white with lower education levels and family incomes. People with insurance were more often male and white with family incomes greater than $25,000 and having at least a high school education. The study found a significant statistical relationship between lack of health insurance and lower utilization of primary care resources, decreased awareness of personal cardiovascular risk factors, poorer control of hypertension and an increase rate of stroke and death.

"We believe that our findings underscore the great importance of medical insurance in maintaining the health of the population," says Fowler-Brown. "As medical science continues to advance, we fear that the health disparities between those who have access to medical care through insurance and those who do not, may continue to grow."
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In addition to Fowler-Brown, who conducted the study as a member of the Division of General Medicine and Epidemiology and the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, the study co-authors include Giselle Corbie Smith, MD, MSc and Joanne Garrett PhD at the University of North Carolina at Chapel Hill and Nicole Lurie, MD. MSPH, of the RAND Corp. of Arlington, VA.

The study was supported by the Health Resources and Services Administration of the US Department of Health and Human Services; the National Heart Lung Blood Institute of the National Institutes of Health and the Robert Wood Johnson Harold Amos Medical Faculty Development Program.

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.harvard.edu

Beth Israel Deaconess Medical Center

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