Published by the Students of Johns Hopkins since 1896
January 28, 2022

Uninsured children more likely to die during hospital stays

By Mali Wiederkehr | November 19, 2009

In the midst of this fresh explosion of health care debate, a striking study released by Hopkins researchers may provide another support pillar for advocates of government-funded insurance coverage.

The study examined high mortality rates in uninsured children, and researchers found that 104,520 of the 22.2 million insured children died during hospitilization, compared to 9,468 of the 1.2 million uninsured children.

This indicates that uninsured children are 60 percent more likely to die in hospitals than their insured counterparts. "If you take two kids from the same demographic background - the same race, the same gender, same neighborhood income level and same number of co-morbidities or other illnesses - the kid without insurance is 60 percent more likely to die in the hospital than the kid in the bed right next to him or her who is insured," David Chang, an author of the study and an assistant professor at the Hopkins School of Medicine, said.

The study encompassed more than 23 million hospital records. The records were collected from 37 states across the U.S. between 1988 and 2005. A very large data pool was necessary for the study given the relatively low rates of death in children.

The researchers recruited children under the age of 18, controlling for gender, race, region of residence, medical condition, hospital type and basis of admission using regression models.

Researchers used statistical simulation in order to find the number of deaths that could be avoided by the possession of health insurance. They were able to predict the number of deaths in the insured group based on the patients' medical condition, subsequently applying this figure to the uninsured group.

Although the study does not explain why child mortality is higher among uninsured children, researchers can speculate as to some possible reasons. Uninsured children were found to have shorter, less expensive hospital visits when they died, averaging $8,058 compared with $20,951 in the insured group.

However, there was no difference between these figures in the insured and uninsured groups with regard to surviving children. In addition, uninsured children had a higher incidence of emergency room visits, suggesting that they were more likely to seek medical attention when their condition was severe.

Sometimes these children arrived at the emergency room at such advanced stages of disease that, they "literally died before the hospital could provide them more care," according to Fizan Abdullah, the lead investigator of the study and a pediatric surgeon at the Hopkins Children's Center. The overwhelming reaction to this study has been in favor of a government-funded healthcare option.

"Thousands of children die needlessly each year because we lack a health system that provides them health insurance. This should not be," Peter Pronovost, co-investigator of the study and director of Critical Care Medicine Hopkins, said.

Furthermore, the data exclude children who died after being discharged from the hospital and those who did not visit the hospital in the first place. Researchers believe this may indicate that the number of uninsured deaths is even higher. If lack of insurance is the palpable cause of increased death rates in children, it seems imperative that measures be taken to provide all children with insurance.

It is easy to draw this conclusion, especially with a study that concerns children and immediately calls for our sympathy. Yet, it is also important to consider that like any retrospective study, the weakness of this one is that the data is prone to bias and cannot prove cause-and-effect. "Can we say with absolute certainty that 17,000 children would have been saved if they had health insurance? Of course not," David Chang said in a press release.

Nevertheless, the researchers appear to have taken great pains to avoid bias, and their conclusions are reasonable (of course, a prospective study would be impossible and unethical). The powerful correlation between the two factors - uninsured children and death is certainly one to consider given the estimated seven million uninsured children in the U.S. today.

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