A newborn child's chances of death or serious illness at birth are linked directly to whether its mother has health insurance, according to a new study that finds a dramatic rise in the number of uninsured mothers in California.
The study, said to be the first to document a long-suspected connection between lack of insurance and infant death and illness, found that the percentage of uninsured women giving birth in Northern California rose by 45% between 1982 and 1986.
By 1986, uninsured babies were 30% more likely than insured babies to die or have serious medical problems, the study found. Blacks especially suffered: Uninsured black babies were more than twice as likely as insured blacks--and four times as likely as insured Anglos--to encounter problems.
"What's very special about this study, and very sad about it, is that this is the first really large study that shows that lack of health insurance is associated with serious illness and death," said Dr. Paula Braveman of UC San Francisco, who headed the study, published today in The New England Journal of Medicine.
In an editorial accompanying the study, two health policy experts contend that the findings offer compelling proof of the need for universal health insurance--which, they note, exists in every industrialized country except the United States and South Africa.
"To be born poor in this wealthy nation is to face more than one's fair share of risk and illness," conclude the authors of the editorial, Dr. Howard H. Hiatt, a professor at Harvard Medical School, and Dr. Donald M. Berwick of Harvard Community Health Plan.
The researchers trace their findings in part to a lack of preventive services and prenatal care among the uninsured. But they also suggest that there may be differences in the hospital care given to insured and uninsured mothers and babies.
As for the recent rise in the number of uninsured mothers, the researchers blame population growth and cuts in employee benefits. They also cite the expansion of the service sector of the economy, in which workers historically have received lower medical coverage.
The long-term consequences of the neglect could not be measured, the researchers say.
"These sickly babies that have serious health problems as newborns are at high risk to never fully realize either their full physical development potential or their full intellectual potential," Braveman said Wednesday in a telephone interview.
In the study, the researchers from UCSF and the San Francisco Department of Public Health examined records of more than 146,000 hospital births in 1982, 1984 and 1986 in San Francisco, Alameda, Contra Costa, San Mateo, Marin, Sonoma, Napa and Solano counties.
The percentage of uninsured newborns rose from 5.5% to 8% during that period, the researchers found. The percentage of uninsured newborns among Latinos in 1986 was 20%--a 140% increase over the level four years earlier.
The risk of problems--as evidenced by death, admission to intensive care or a prolonged hospital stay--increased steadily for the uninsured babies. In 1982, they were 11% more likely than their counterparts to encounter trouble; by 1986, that added risk had risen to 31%.
The increased risk for blacks was especially severe: Uninsured black babies were more than twice as likely as insured black babies to die or have medical problems. Uninsured Latinos were 56% more likely than insured Latinos to encounter problems.
When compared to privately insured Anglo babies, the differences are even more stark: Uninsured Asian, black and Latino newborns, respectively, were 1.4, nearly two, and more than four times more likely to die or suffer health problems.
HEALTH RISKS TO NEWBORNS
The percentage of newborns without health insurance in the years 1982, 1984 and 1986, according to a study of eight Northern California counties:
ALL NEWBORNS % 1982 5.5 1984 6.2 1986 8.0 % change 45 ASIANS 1982 7.8 1984 8.5 1986 12 % change 54 BLACKS 1982 2.7 1984 3.0 1986 3.4 % change 26 LATINOS 1982 8.2 1984 12.5 1986 19.7 % change 140 ANGLOS 1982 5.1 1984 5.0 1986 5.5 % change 8
The chances of an adverse hospital outcome (death, prolonged hospital stay, transfer to another hospital) among the uninsured versus the privately insured newborns. Expressed as the percentage of higher risk for the uninsured:
ALL NEWBORNS % 1982 11 1984 19 1986 31 ASIANS 1982 -6 1984 94 1986 3 BLACKS 1982 -6 1984 13 1986 124 LATINOS 1982 24 1984 -1 1986 56 ANGLOS 1982 20 1984 44 1986 9