Harvard study finds nearly 45,000 excess deaths annually linked to lack of health coverage

A study published online today estimates nearly 45,000 annual deaths are associated with lack of health insurance. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.

The new study, “Health Insurance and Mortality in U.S. Adults,” appears in today’s online edition of the American Journal of Public Health.

The Harvard-based researchers found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

Lead author Dr. Andrew Wilper, who worked at Harvard Medical School when the study was done and who now teaches at the University of Washington Medical School, said, “The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health. We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease – but only if patients can get into our offices and afford their medications.”

The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking education, income and many other factors including smoking, drinking and obesity into account. It estimated that lack of health insurance causes 44,789 excess deaths annually.

Previous estimates from the IOM and others had put that figure near 18,000. The methods used in the current study were similar to those employed by the IOM in 2002, which in turn were based on a pioneering 1993 study of health insurance and mortality.

Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease.

An increase in the number of uninsured and an eroding medical safety net for the disadvantaged likely explain the substantial increase in the number of deaths associated with lack of insurance. The uninsured are more likely to go without needed care.

Another factor contributing to the widening gap in the risk of death between those who have insurance and those who don’t is the improved quality of care for those who can get it.

The research, carried out at the Cambridge Health Alliance and Harvard Medical School, analyzed U.S. adults under age 65 who participated in the annual National Health and Nutrition Examination Surveys (NHANES) between 1986 and 1994. Respondents first answered detailed questions about their socioeconomic status and health and were then examined by physicians. The CDC tracked study participants to see who died by 2000.

The study found a 40 percent increased risk of death among the uninsured. As expected, death rates were also higher for males (37 percent increase), current or former smokers (102 percent and 42 percent increases), people who said that their health was fair or poor (126 percent increase), and those that examining physicians said were in fair or poor health (222 percent increase).

Dr. Steffie Woolhandler, study co-author, professor of medicine at Harvard and a primary care physician in Cambridge, Mass., noted: “Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives.”

She added: “Even the most liberal version of the House bill would have left 17 million uninsured, according to the Congressional Budget Office. The whittled down Senate bill will be worse – leaving tens of millions uninsured, and tens of thousands dying because of lack of care. Without the administrative savings only attainable through a Medicare-for-all, single-payer reform – real universal coverage will remain unaffordable. Politicians are protecting insurance industry profits by sacrificing American lives.”

Dr. David Himmelstein, study co-author and an associate professor of medicine at Harvard, remarked, “The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance. Even this grim figure is an underestimate – now one dies every 12 minutes.”

Download “Health Insurance and Mortality in U.S. Adults,” by Andrew P. Wilper, M.D., M.P.H., Steffie Woolhandler, M.D., M.P.H., Karen E. Lasser, M.D., M.P.H., Danny McCormick, M.D., M.P.H., David H. Bor, M.D., and David U. Himmelstein, M.D. American Journal of Public Health, Sept. 17, 2009 (online); print edition Vol. 99, Issue 12, December 2009.


  1. Carol T. Wallitt on September 17, 2009 at 8:39 pm

    HR 676!!!!!!!!!!!!!!!!!!!!!


    (= HR 3200)

  2. RW on September 19, 2009 at 1:17 am

    Bunch of bull-crap. In the own words of the article, “estimate”. Statistics lie and lairs use statistics. Your pushing propaganda to gain uneducated support to pass a massive lame duck health care bill. I for one am tired of paying for all the lazy people. Secondly, there are many people in poor health due to their habbits. Why should someone else pay for that? Third, the problem is not being addressed which is the cost driven up by attorneys and idiot judges that award millions for people with illegitimate claims.

    What makes anyone think they have a “right” to “free” health care anyways. You have the responsibility to take care of yourself. You don’t have the right to force your socialized ways onto everyone else.


    • Michelle on September 21, 2009 at 1:53 pm

      Lazy…leeches? What a judgemental and self-rightous statement! There are just as many lazy ‘loaded’ leeches as there are poor without insurance. Not having insurance or being underinsured does NOT make you a lazy leech!
      Make sure if you lose your job you’ve got hundreds of dollars monthly to pay insurance premiums especially if you’re over 45.Or you could take a gamble on a ‘cheap’ policy and find out exactly what the fine print says they won’t pay when you do get ill.

      My mother has worked since she was 15 – but was diagnosed with breast cancer after her company went out of business and she ran out of money for premiums. She was neither lazy or a leech. Thank you.

    • Keith on September 21, 2009 at 3:45 pm

      Insurance pools a large group of people and has for a long, long time. You already pay for the ‘lazy leeches’ if you have insurance whether you have a private or public policy. Getting people off their duff is an educational issue and a topic for another story.

    • Nick Lento on September 21, 2009 at 5:53 pm

      Dear “RW”

      The study was conducted by folks with national reputations and first rate credentials. Have you read it?

      Which facts, specifically, do you disagree with, and why?

      Who are you?

      What are your credentials?

      RW, your “critique” comes off as the same old intellectually bankrupt non-sense that we get form Glen Beck and the rest of the rabid wretches who irrationally oppose real health care reform.

      Unless you’re willing to have us become a society that simply allows all of the poor and sick to simply die on the street….it’s actually far more expensive to let them get sick to the point of dying and then have the poor sick suffering folks show up, or be brought to, an ER where they are admitted and receive critical care until they die.

      Bottom Line: Single payer would actually be CHEAPER, much much cheaper, in the long run.

      In other words, RW doing the morally righteous thing and the most financially sound thing are mutually inextricable and reinforcing in this case.

      The ONLY remotely reasonable “rationale” for keeping the status quo comes from the insurance industry for reasons that are 100% $elf $erving. For everyone else, the truth is clear. Single Payer is the best solution to the existing health care problem.

  3. circe5 on September 19, 2009 at 11:40 am

    First let me be clear that I am insured. I am 56 & own a small struggling retail store. My health insurance policy costs me $6000 a year. In order to have such a “low” premium, I have a deductible of $2500. I have almost no extra money after paying my basic bills. I can’t afford to go to the doctor although I have some real health issues. I fell last year and tore muscles in my leg. I need physical therapy but I can’t afford it. It is difficult for me to walk and it keeps getting worse. My quality of life has greatly deteriorated. I can see myself in a wheelchair in a few years. Blood was found in my urine 3 years ago. I took the tests I could afford but the cause wasn’t found. I can’t afford further tests. Maybe I will end up on kidney dialysis because I have an untreated condition. All I can do is to hope that I don’t. People in my situation who are under-insured are really in a bind. We are not poor enough for Medicaid or rich enough to have good insurance with a low deductible

  4. Eric B. Ross on September 21, 2009 at 1:34 pm

    I’ve lived in Great Britain for 12 years and have direct, personal experience of that country’s National Health Service. It is a civilized way for a developed society to deal with the health needs of its people, regardless of their age, gender or income. No one ever has to worry about being denied essential treatment because they cannot afford it.

    For those who don’t understand it, the NHS is not, technically, “free.” You pay a contribution out of your income. But, if you have no income, either because you’re too young or too old or have become unemployed, you are treated the same, without any loss of attention or dignity. At the end of the day, however, such a single-payer system such as the NHS costs an individual far, far less than what the average insured U.S. citizen pays in premiums –and the British never have to worry about co-pays and deductibles or caps and certainly never have a profit-oriented insurance company deciding which doctor they can see or treatment they can have.

    • Marcia on September 22, 2009 at 1:45 pm

      “A study published online today estimates nearly 45,000 annual deaths are associated with lack of health insurance.”

      This study is as phony as a 3 dollar bill. No one dies from lack of health insurance. Hey, people still die with health insurance too.

      Eric B Ross writes: “I’ve lived in Great Britain for 12 years and have direct, personal experience of that country’s National Health Service. It is a civilized way for a developed society to deal with the health needs of its people, regardless of their age, gender or income. No one ever has to worry about being denied essential treatment because they cannot afford it.”


      “A U.K. grandmother has been waiting 13 years for a hip replacement”


      a 4-year-old girl with several absessed teeth has been waiting in agony over a month for “urgent” dental care:


      10-month wait for cancer treatment


      Cancer patients ‘wait too long’


      Grandmother dies after NHS cancer treatment is withdrawn because she paid privately for life-extending drug


      Hospital says sorry for grandmother’s fatal wait.


      Those are just a few of thousands upon thousands of examples from the UK. Is it “civilized” to make a grandmother wait 13 years for a hip replacement? (In the United states, thats practically unheard of, even for the uninsured). Is it “civilized” make a 4 year old girl wait over a month for much needed emergency dental care? Or is it “civilized” to make people wait many months to get cancer treatment (which has caused people to die as cancers dont wait to spread. They need to be treated as soon as possible, and for many, a 10 month wait can be fatal), or cut off treatment completely because one seeks to supplement their treatment out of their own pocket?

      • Chuck Infantino on September 23, 2009 at 9:32 am

        The statistic you site for a 10 month wait for cancer treatment was taken in October 1997. It is not current. The Canadians and Europeans I talk to say they are happy with their health care systems. Their may be isolated problems, but they don’t have to worry about being financially wiped out if they get a serious illness. They would never trade what they have with what we have, which is a for profit health care system that benefits insurance and pharmaceutical companies. Why is it that most U.S. doctors and nurses support either a single payer system or a system with a public option? It is because they know the problems with our for profit health care system up close and personal. They are getting tired of fighting with insurance companies for approval of treatment or for payment of services. If we would get out of Iraq and Afghanistan and repeal the Bush tax cuts for the wealthy we would have the money for a single payer system. Too many senators and representatives are in the pockets of the for profit health care industry. What we have in this country is a “government of the corporations, by the corporations, and for the corporations”. Our founding fathers would roll over in their graves if they knew what was going on. Let me refer you to a quote from Thomas Jefferson in 1800: ” I pledge eternal hostility against every form of tyranny of man”. He was referring to tyranny in our own country as well the rest of the world. Wake up America!

        • Marcia on March 26, 2010 at 5:07 am

          “Why is it that most U.S. doctors and nurses support either a single payer system or a system with a public option?”

          Answer: They dont. Thats a complete falsehood. Most are against that.

          “If we would get out of Iraq and Afghanistan and repeal the Bush tax cuts for the wealthy we would have the money for a single payer system.”

          No we wouldnt. The Wars in Iraq and Afghanistan cost somewhere around 60-80 billion dollars a year. Thats not nearly enough to run a single payer system. Plus if we pulled out of Iraq and Afghanistan, you’d find that the costs wouldnt come down much because the vast majority of those funds go to our troops. So if we pulled them out of Iraq and Afghanistan, whether we send them home to the United States and/or put them in other countries, we still would have to pay that expense.

          And the bush tax cuts are not for the wealthy alone. They applied to middle class and poor people too. Whats more a tax cut doesnt cost us anything. Its not an expenditure like the wars. When you give people a tax cut, youre not giving them anything out of governments pocket. You are simply letting them keep more of what they earn. Besides which, those tax cuts will expire (or rather have expired)

  5. joe on September 21, 2009 at 1:35 pm

    RW – I believe I have a right to “free” healthcare just like i believe I have a right to “free” (socialist) police protection or a “free” (socialist) fire department or the ability to travel on our mostly “free” (socialist) interstate system or have the national defended by our “free” (socialist) military.

    one would say these are not free.. and I agree.. they are obviously paid for by taxes. most would also say (minus healthcare) that these are all non-negotiable necessities… i see no difference for healthcare.

    these are all necessities.. and that’s why I see them as rights.
    without universal healthcare (not obamacare mandates) you are paying for all the uninsured anyway!

    as for malpractice. i suggest you look up the statistics..
    they are not as massive when it comes to percentages of money spent and earned as the neo-cons would like you to believe.

    and as for government run care, which the current proposed bills really lack, all the protesters on medicare seem to love their government run care. quite ironic.

  6. Janet on September 21, 2009 at 4:31 pm

    The news media can talk about everything under the sun but those Dying From having No Health Care

    Country of Christians you say, the majority yes the 20% screaming and promoting violence absolutely not

    No doubt these folk sit in “CHURCH” every single Sunday and then Monday thru Saturday rebell against their followman in favor of violence and hate

    Too many are dying because of having no access to health care

    Havard Studies are acceptable to the group screaming and bashing this report when it applies to anything else

    The U.S. is no longer the Beacon or the example for other countries letting people die with no access to health care is the same as “Human Rights Abuse” that we are quick to say about other countries

    We are the only country in the industrialized world who does not take care of the Sick and Elderly

    It’s shameful

    It’s time for this to stop.

    Either stop claiming to be a Nation of Christians when you spew hate and distain for your fellowmen and women

    Or Just admit you 20% who love to embrass the 80% that you are a bunch of Hipocrits in the Bibical Sense

  7. DBarr on September 23, 2009 at 11:44 am

    Re the comment about the “lazy”: There are a number of code words that should always put the reader on alert. “Lazy” in the lexicon of the right means “colored person who will not work for as little as I would like him/her to.” In every case, when dealing with the right, attitudes can be traced back to the Confederate States Of America.

    Of course, the way to immediately convert a neo-confederate is to deny him or her their piece of socialism; listen to them howl if their roads don’t get built or their electricity goes out. Or if some clerk at city hall doesn’t get back to them on a complaint fast enough.

    They do not understand democracy, and there is a question whether they want or even like it. Remember, this is the side that prefers to shoot leaders than allow the slow, annoying process of the vote to work; remember the Kennedys and King, and the Tea-Baggers bringing guns to health-care rallies.

  8. roberta on September 23, 2009 at 12:33 pm

    People are very selective about what they call ‘socialism.’ I remember Michael Moore’s TV Nation show back in the 90s in which he interviewed (selectively of course) citizens of Newt Gingrich’s home Cobb County and huge amounts of people wanted ‘the government off their backs’ and “no taxes’ –Moore pointed out that their reservoirs of drinking water, highways, etc, were the result of the government and their taxes and such. These folks sounded exactly like the ‘no socialism’ ones at the big Fox media event in DC last weekend. Now I saw on the news this morning that there is massive flood damage, much of it in Cobb County. How many of them are going to turn down federal aid for all the damage that their insurance companies are going to bail out on?

    Too many Americans only seem to care about their own immediate family needs being met. As for anyone else who may have had misfortune or made poor choices (who among us has not at some time?), they are cold-hearted and selfish and cruel and proud to express this. Empathy for our fellow human beings is denigrated as ‘liberal social justice’. What happened to our country?

  9. george on September 25, 2009 at 7:25 pm

    The insurance companies are the REAL leeches on the backs of society. They get paid billions a year just for taking our money and passing it to the health care providers. They are useless middlemen, who do NOTHING for our health. Their CEO’s are paid tens of millions a year. Health care has risen 3-4X the rate of wage increases. Much faster than the inflation rate. It causes more bankruptcies than anything else. We pay around twice what other countries pay per capita, yet we have poor quality and outcomes. WHO ranks U.S. # 37 in quality. France is #1 andhas national health care. It is ILLEGAL for insurance companies to make a profit off of health care in EVERY other industrialized nation. We pay taxes for our socialist Fire Dept. to put out our house. Isn’t our body more important than our house? We should “promote the general welfare” as the Constitution prescribes. We are entitled to “life, liberty, and the pursuit of happiness.”How can we have life if we have a deadly illness, but can’t afford to see a doctor? Government works if we MAKE it work. Wake up and join the 21st century, and stop living in the stone age of health care. We don’t even HAVE a health care system in the U.S. All we have is a health insurance racket system, who gets paid to deny us health care.

  10. BARB BF on October 9, 2009 at 11:34 am


    In 1999, a report by the Institute of Medicine (IOM) claimed that nearly 98,000 people die each year as a result of completely preventable medical errors. Ten years later, things have only gotten worse. The latest report by the Consumers Union claims that medical errors are causing more preventable deaths than ever — over 100,000 each year.

    That makes over a million preventable deaths in the last 10 years.

    These types of gruesome statistics aren’t the least bit surprising. The huge, impersonal health care system is capable of swallowing patients whole and losing them in an increasingly vast shuffle.

    The worst part about this whole thing is that these medical errors are usually not the grandiose kinds that make the headlines, such as surgeons removing or transplanting the wrong organs. It’s easily preventable things like wrong prescriptions, improper dosages, and poorly administered treatments.

    Not long ago, I wrote about a study published in the medical journal Quality and Safety in Health Care that detailed deadly medical errors that occurred in doctor’s offices — before patients even made it to the hospital! The study showed that 82 percent of the errors were caused by so-called “system malfunctions.” One patient died because a message was not delivered on time.

    As disturbing as this is, I shudder to think about how much worse they’re likely to get when the health care system is hijacked by Obama’s bureaucrats.

    Try to name just one thing that’s run better after it’s been taking over by a government bureaucracy.

    Besides, the Obama Administration has bungled the takeover of the U.S. auto industry. Why should we trust them to do any better with health care?

  11. kc on October 31, 2009 at 6:30 pm

    People die with or without health insurance. Lack of insurance does not equate to lack of healthcare. People in this country seem to be brainwashed. Every person without regard to ability to pay can and do get free healthcare through the emergency rooms and free clinics which allbeit not as nice as private, but nevertheless free. The poor qualify for medicaid. There are 15 million uninsured who make over 57,000 dollars per year and could afford health insurance but choose not to. 12 million are illegal aliens. Very few actually fall in the hole between being eligible for medicaid and truly not make enough money to afford insurance (although they have a car, cell phone, and an ipod). We can easily expand medicaid to make those eligible. That in combination with allowing health insurance companies to compete across state lines, and tort reform (3-5% total savings on healthcare) would solve our problems without trying to “fix” the entire system.

  12. John Lloyd Scharf on November 5, 2009 at 12:29 pm

    If health care is the problem, insurance is not the cause and government is not the answer.
    Of those “50 million,” that lack insurance there were 45,000 who died without health care.
    WITH health care, 98,000 died FROM health care because of malpractice.
    The question is do we want to trust that largest corporation in the world, the U.S. Government. Do not expect house calls anytime soon.
    We have seen how well the government delivers on its promises and its bureaucracies pursue the money without giving us benefits on so many levels.
    Imagine another 111 bureacracies that only ultimately must listen to the Secretary of the Treasury – another “service” of which is the IRS.
    That blog of mine above has several .pdf connections (HR. 3962 and two summaries, a few videos, and page references for new taxes and other mandates).
    If you cannot use the link, google “Progressive Capitalist H.R. 3962.”
    If you believe the promises of this bill, you have to deal with the lie that it fosters competition with a government option called the “Public Option” and establishes the government as a monopoly making its own rules. Don’t worry. You’ll run out of “rich” soon enough.
    We have at least a $12 trillion economy of which at least $1.8 trillion is spent on health care.
    If you read the bill, there are plenty of opportunities to soak the middle class, if you do not mind the 1.6 million made jobless.
    REPUBLICAN Affordable Health Care For America Act
    MAKING HEALTH Care Affordable For EVERY AmeriCAN