Evidence map›Paper›PMID 18678844›Full record

ArticleAnnals of internal medicine2008

A national study of chronic disease prevalence and access to care in uninsured U.S. adults.

Andrew P Wilper, Steffie Woolhandler, Karen E Lasser, Danny McCormick, David H Bor, David U Himmelstein

Abstract read
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In one paragraph

Article in Annals of internal medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
82citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

82 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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22 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Andrew P WilperCambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts 02139, USA. awilper@hsph.harvard.edu
Steffie Woolhandler
Karen E Lasser
Danny McCormick
David H Bor
David U Himmelstein

Funding

PHS HHS 5T32 HP110011
6 · The paper itself

Abstract

backgroundNo recent national studies have assessed chronic illness prevalence or access to care among persons without insurance in the United States.

objectiveTo compare reports of chronic conditions and access to care among U.S. adults, by self-reported insurance status.

designPopulation-based survey.

settingNational Health and Nutritional Examination Survey (1999-2004).

participants12,486 patients age 18 to 64 years. MEASUREMENTS: Estimates of national rates of cardiovascular disease, hypertension, diabetes, hypercholesterolemia, active asthma or chronic obstructive pulmonary disease, previous cancer, and measures of access to care.

resultsOn the basis of National Health and Nutrition Examination Survey (1999-2004) responses, an estimated 11.4 million (95% CI, 9.8 million to 13.0 million) working-age Americans with chronic conditions were uninsured, including 16.1% (CI, 12.6% to 19.6%) of the 7.8 million with cardiovascular disease, 15.5% (CI, 13.4% to 17.6%) of the 38.2 million with hypertension, and 16.6% (CI, 13.2% to 20.0%) of the 8.5 million with diabetes. After the authors controlled for age, sex, and race or ethnicity, chronically ill patients without insurance were more likely than those with coverage to have not visited a health professional (22.6% vs. 6.2%) and to not have a standard site for care (26.1% vs. 6.2%) but more likely to identify their standard site for care as an emergency department (7.1% vs. 1.1%) (P <0.001 for all comparisons). LIMITATION: The study was cross-sectional and used self-reported insurance and disease status.

conclusionMillions of U.S. working-age adults with chronic conditions do not have insurance and have poorer access to medical care than their insured counterparts.

Indexed as

Health Services AccessibilityMedically UninsuredAdolescentAdultChronic DiseaseComorbidityCross-Sectional StudiesFemaleHumansMaleMiddle AgedNutrition SurveysPrevalenceUnited States

Identifiers

PMID18678844

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.