THURSDAY, April 23 (HealthDay News) -- People without health insurance have about the same mortality rate as people with health insurance, according to an observational study published online April 21 in Health Services Research.

Richard Kronick, Ph.D., of the University of California at San Diego School of Medicine in La Jolla, and colleagues followed up on 672,526 adults ages 18 to 64 years who reported being uninsured or insured privately on the National Health Interview Survey during the years 1986 to 2000. From the survey baseline, mortality in the group was followed through 2002. Cox proportional hazard survival analysis was used to assess the association between insurance status and mortality.

Researchers found that the risk of mortality for uninsured survey respondents was not significantly different than respondents who had employer group insurance (hazard ratio, 1.03 after adjustments for health status, demographics and health behaviors). Leaving health status out of the adjustment calculation increased the risk of mortality (hazard ratio, 1.10) and leaving smoking status and body mass index out of the adjustment calculation also increased the risk of mortality (hazard ratio, 1.20).

"The Institute of Medicine's estimate that lack of insurance leads to 18,000 excess deaths each year is almost certainly incorrect. It is not possible to draw firm causal inferences from the results of observational analyses, but there is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States," the authors write.

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