Malkin distorts study on high mortality rates of uninsured in failed attempt to debunk it

››› ››› JUSTIN BERRIER

In her October 23 column, Michelle Malkin attacked progressives citing the number of annual deaths due to lack of health insurance, a figure she described as the "bogus death statistic." In doing so, Malkin misrepresented the methodology of the study from which this statistic is gleaned.

Study concluded: "The uninsured are more likely to die than are the privately insured"

Study found lack of insurance was a factor in almost 45,000 deaths each year. The study, "Health Insurance and Mortality in US Adults," concluded that those without insurance had a higher mortality rate than those with insurance. By applying that ratio to 2005 census data, the study concluded that lack of insurance was a factor in almost 45,000 deaths every year. The report concluded that "[u]ninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time."

Malkin distorted the study's methodology in attempt to debunk statistic

Malkin claimed study counted uninsured who died and "attributed deaths to lack of health insurance." Calling the results of the study "a phantom number," Malkin claimed that in their study, "Drs. [David] Himmelstein, [Steffie] Woolhandler, and company then crunched the numbers and attributed deaths to lack of health insurance for all the participants who initially self-reported that they had no insurance and then died for any reason over the 12-year tracking period." From Malkin's October 23 syndicated column:

Democrat Rep. Alan Grayson of Florida has found his calling: Death demagogue. First, he accused Republicans of wanting sick patients to "DIE QUICKLY." Next, he likened health insurance problems to a "Holocaust in America." Now, he's unveiled a new website entitled "namesofthedead.com" in memory of the "more than 44,000 Americans [who] die simply because they have no health insurance."

Just one problem: The statistic is a phantom number. Grayson's memorial, like the Democrats' government health care takeover plan itself, is full of vapor. It comes from a study published last December in the American Journal of Public Health. But the science is infused with left-wing politics.

[...]

So, how did these political doctors come up with the 44,000 figure? They used data from a health survey conducted between 1988 and 1994. The questionnaires asked a sample of 9,000 participants if they were insured and how they rated their own health. The federal Centers for Disease Control tracked the deaths of people in the sample group through the year 2000. Drs. Himmelstein, Woolhandler, and company then crunched the numbers and attributed deaths to lack of health insurance for all the participants who initially self-reported that they had no insurance and then died for any reason over the 12-year tracking period.

Study compared mortality rates of insured and uninsured, then controlled for risk factors, finding health insurance still predictor of mortality rates

The study used a nationally representative sample to determine comparable mortality rates between insured and uninsured. After determining that insurance status is a predictor of mortality, the researchers compared the mortality rates of the insured and the uninsured by using data from the Center for Disease Control's Third National Health and Nutrition Examination Survey to determine the increase in mortality due to uninsurance. The study found that "[a]mong all participants, 3.1%" died. "The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only was 1.80 (95% CI=1.44, 2.26)."

The study then controlled for well-known risk factors to determine whether insurance affected mortality rates. The study controlled for many well-known risk factors such as age, race/ethnicity, smoking habits, alchohol habits, body weight, and poverty. It found: "After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use, the uninsured were more likely to die (hazard ratio=1.40; 95% CI=1.06, 1.84) than those with insurance."

The study applied hazard ratio to census data to estimate that approximately 45,000 people in 2005 died from lack of health insurance. From the report:

In the model adjusted only for age and gender, lack of health insurance was significantly associated with mortality (hazard ratio [HR]=1.80; 95% CI=1.44, 2.26). In subsequent models adjusted for gender, age, race/ethnicity, poverty income ratio, education, unemployment, smoking, regular alcohol use, self-rated health, physician-rated health, and BMI, lack of health insurance significantly increased the risk of mortality (HR=1.40; 95%CI=1.06,1.84; Table 2). We detected no significant interactions between lack of health insurance and any other variables. Our sensitivity analyses yielded substantially similar estimates.

Replicating the methods of the IOM panel with updated census data and this hazard ratio, we calculated 27424 deaths among Americans aged 25 to 64 years in 2000 associated with lack of health insurance. Applying this hazard ratio to census data from 2005 and including all persons aged 18 to 64 years yields an estimated 35327 deaths annually among the nonelderly associated with lack of health insurance. When we repeated this approach without age stratification, (thought by investigators at the Urban Institute to be an overly conservative approach) we calculated approximately 44789 deaths among Americans aged 18 to 64 years in 2005 associated with lack of health insurance.

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Health Care, Health Care Reform
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Michelle Malkin
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