Research Activities, March 2014
Lack of insurance and poorer health create double jeopardy for blacks and Hispanics
Blacks and Hispanics are not only more likely to be uninsured than whites, but they also report worse health at most ages compared to whites. This leads to a situation where minorities face living in health insurance "double jeopardy:" being uninsured while also in poorer health and, therefore, at higher risk of needing medical care, concludes a new study by AHRQ researcher, James B. Kirby, Ph.D., and Toshiko Kaneda, Ph.D.,of the Population Reference Bureau. The rates of disability and ill health begin rising among the near-elderly before age sixty-five. The study found that the black-white difference in the proportion of uninsured was at its widest in the 55–59 age group (12 percent) and the Hispanic-white difference was near its widest in the 40–45 age group (29 percent), both ages when medical needs are likely rising. This may translate into more years spent in insurance double jeopardy.
When the researchers focused on the expected years of life spent in the double jeopardy of being uninsured and in poorer health, they estimated that the expected years of life spent in double jeopardy was 11 years for Hispanics, compared to 6 years for blacks and 4 years for whites.
Overall, the researchers found that Americans can expect to live 13 years without health insurance coverage, which makes up 17 percent of their total life expectancy. But the racial and ethnic disparities are stark: Hispanics can expect to live 24 years without health insurance coverage compared to 14 years for blacks and 10 years for whites. There are also large differences in years spent in the other insurance categories. Both blacks and Hispanics can expect to live well over twice as many years covered by Medicaid compared to whites (15 and 13 years vs. 6 years).
The researchers suggest that the life expectancy measures used in their study have the potential to reframe the discussion of disparities toward a focus on disadvantage over a lifetime. The findings were based on mortality data for 2008 from life tables published by the National Center for Health Statistics and self-reported insurance and health status for 2008 from AHRQ's Medical Expenditure Panel Survey, a series of nationally representative, longitudinal surveys that collect information for the U.S. civilian, noninstitutionalized population.
See "Double jeopardy measure suggests blacks and Hispanics face more severe disparities than previously indicated," by James B. Kirby, Ph.D., and Toshiko Kaneda, Ph.D., in Health Affairs 32(10), pp. 1766-1772, 2013. Reprints (AHRQ Publication No. 14-R009) are available from AHRQ.