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Insurance status and health-related quality-of-life disparities after trauma: results from a nationally representative survey in the US

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Abstract

Purpose

To determine whether insurance status modifies the association between injuries and health-related quality of life (HRQOL) in a nationally representative sample of US adults.

Methods

This is a longitudinal, observational study using the pooled 2000–2006 Medical Expenditure Panel Survey (MEPS). A total of 50,225 adults (age ≥18) with or without injuries were included in the study. HRQOL was evaluated using the EuroQoL Health Index (EQ-5D), visual analog scale (VAS), and the SF-12 physical component score (PCS) and mental component score (MCS). A categorical variable of injury-insurance combinations was created (not injured-privately insured, not injured-publically insured, not injured-uninsured, injured-privately insured, injured-publically insured, or injured-uninsured) and was included in the linear regression models. Adjustment covariates included age, gender, education, race, diabetes, hypertension, and baseline self-reported health. Healthcare utilization was also examined among the study population by injury status and across insurance groups.

Results

Seven hundred and ten individuals reported injuries. Adjusted analyses showed that injured individuals with public insurance had lower EQ-5D (−0.25), VAS (−11.4), PCS (−8.5), and MCS (−4.9) than the privately insured controls, while uninsured had EQ-5D, VAS, PCS and MCS that were, respectively, −0.12, −7.2, −2.6 and −4.1 relative to privately insured controls. With the exception of hospital discharges, healthcare utilization among uninsured individuals was lower than those with public or private insurance.

Conclusions

We found injured individuals to have lower HRQOL than those without injuries, and this effect was exacerbated by insurance status. These findings call for interventions aimed to narrow the outcome disparity among injured in the US.

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Author information

Authors and Affiliations

  1. King Abdullah International Medical Research Center (KAIMRC), Saud Bin Abdulaziz University for Health Sciences, KSAU-HS, Riyadh, 11426, Saudi Arabia

    Suliman Alghnam

  2. Assistant Professor of Surgery, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA

    Eric B. Schneider

  3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, Hampton House 543, Baltimore, MD, 21205, USA

    Renan C. Castillo

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  1. Suliman Alghnam
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Correspondence to Suliman Alghnam.

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No funding was used to conduct the study, and all authors have not conflict of interest to declare.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study used de-identified information that is publically available from the Agency of Healthcare Research and Quality.

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Alghnam, S., Schneider, E.B. & Castillo, R.C. Insurance status and health-related quality-of-life disparities after trauma: results from a nationally representative survey in the US. Qual Life Res 25, 987–995 (2016). https://doi.org/10.1007/s11136-015-1126-0

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