Health Disparities
Disparities in mean years of potential life lost from all-cause mortality by health insurance, mental health, and health behaviors in the US, 1997—2019 David Adzrago* David Adzrago Adzrago NIH/NIMHD
Introduction: Years of Potential Life Lost (YPLL) is a population health metric that quantifies premature mortality and its associated socioeconomic impact. While health insurance coverage is strongly linked to mortality risk, differences in mean YPLL by insurance status across mental health and health-related behaviors remain understudied. We assessed differences in mean YPLL between insured and uninsured adults across psychological distress (PD), BMI, smoking status, alcohol consumption, and physical activity (PA).
Methods: This population-based cohort study included adults aged > 18 years (N= 54,433) from the 1997–2018 National Health Interview Surveys linked to 1997–2019 National Death Index data. YPLL was calculated by deducting age at death (18–74) from a standard age of 75 years and then summing each YPLL across individual deaths. Analyses accounted for the complex survey design.
Results: The overall mean YPLL was 10.3 years (95% CI= 10.2, 10.5). Compared with insured adults, uninsured adults at baseline who died had an excess mean YPLL of 10.5 (95% CI=10.0–11.0). Uninsured adults consistently experienced significantly higher mean YPLL across all PD levels, BMI categories, smoking status, alcohol consumption, and PA. Excess YPLL among uninsured adults ranged from 6.5 to 11.7 years across PD levels, 9.0 to 11.0 years across BMI, 8.1 to 11.1 years by smoking status, 8.3 to 11.3 years by alcohol use, and 9.4 to 14.8 years across PA levels. Differences were largest among adults meeting both aerobic and strength PA guidelines and smallest among those with severe PD.
Conclusions: Uninsured adults experienced higher premature mortality than insured adults irrespective of mental health status and health-compromising or health-promoting behaviors. These findings suggest that expanding access to health insurance and integrating primary and behavioral health interventions may contribute to reducing premature mortality disparities between uninsured and insured individuals.