According to a study published online in the Journal of General Internal Medicine, insurance status is a better predictor of survival after a serious cardiac event than race, and may help explain racial disparities in health outcomes for cardiovascular disease.

The new study, conducted by Derek Ng from the Johns Hopkins Bloomberg School of Public Health in the US, demonstrates that race is not associated with a higher risk of mortality but that being underinsured is a strong predictor of death amongst hospital admissions with a serious cardiac event.

The burden of illness and premature death amongst African Americans living in poor, urban neighborhoods is high, particularly in terms of cardiovascular disease. Insufficient treatment and ultimately premature death could be major outcomes of being underinsured or lack of health insurance, although to what extent these observed racial disparities are in fact due to insurance status rather than to race itself remains unclear.

Ng and his team decided to investigate the relationship of a premature death risk with race or insurance status, taking the potential effects of neighborhood socioeconomic status and disease severity into consideration. They analyzed data from a sample of patients who were admitted to one of three Maryland hospitals for three specific cardiovascular events, i.e. 4,908 patients with acute myocardial infarction better known as heart attacks and 6,758 patients with coronary atherosclerosis or clogged arteries as well as 1,293 stroke patients.

The findings revealed that those who were underinsured died sooner compared with those who had private insurance, and that the survival rates between whites and blacks were similar. The determined that the risk of premature death independent of race, neighborhood socioeconomic status and disease severity following a heart attack was 31% higher in those who were underinsured and 50% higher in those following atherosclerosis.

The team concludes:

“Among those admitted to the hospital with an acute cardiovascular event, there was an increased risk of mortality among subjects who were underinsured compared to those who had private insurance. Given the recent changes in health insurance and healthcare reform, these results underscore the need to closely investigate the factors relating to health insurance that may explain these disparities. Indeed, targeting these factors may relieve the burden of mortality disproportionally affecting those who are underinsured.”

Written by Petra Rattue