Differences in Mortality Between the Pre-Medicare and Medicare Age-Groups in Arkansas

BACKGROUND:  Arkansas citizens in the pre-Medicare age-group, 40 to 64 years, lack insurance when compared to the nation. The percent of the population without healthcare insurance significantly exceeded the U.S. percent in 2011 (19.5% ± 0.7, 16.6% ± 0.1, respectively).   It is predicted that mortality rates in Arkansas will be higher than the rates in the same group in the U.S.  To assess this difference, trends during 1968 to 2010 in mortality rates from all causes and leading causes; coronary heart disease, cancer, and stroke, among the pre-Medicare age-group were compared to corresponding U.S. rates.  Next, the analogous comparison was performed between Arkansas and U.S. mortality rates for the same causes of death among the automatically insured, Medicare, age-group of 65+ years.

METHODS:  Uninsured healthcare rates for persons between the ages of 40 to 64 were obtained from the U.S. Census Bureau. Mortality rates were obtained from the CDC Wonder compressed mortality file from 1968 to 2010.  Causes of death were determined using ICD-8, ICD-9, and ICD-10 coding for the available age-groups, pre-Medicare group, 45 to 64 years, and the Medicare group, 65+ years. To measure the differences between the Arkansas and U.S. mortality rates among the age-groups, percent differences were calculated using combined 6-year age-specific rates. The number of excess Arkansas deaths were calculated by adjusting the age-specific U.S. mortality rates to the Arkansas population and then measuring the difference.

RESULTS:  For the pre-Medicare age-group from 45 to 64, the overall mortality rate in Arkansas from 2005 to 2010 was 34 percent higher than the national rate. For coronary heart disease, the rate was 62 percent higher, for cancer, the rate was 26 percent higher, and for stroke, the rate was 54 percent higher than the corresponding U.S. rates. Among the Medicare age-group, 65+ years, the death rates were more similar to the national rate. It was only 8 percent higher for the period from 2005 to 2010 for all causes, 8 percent higher for coronary heart disease, 6 percent higher for cancer, and 25 percent higher for stroke.

CONCLUSIONS:  If the pre-Medicare age group in Arkansas had the same death rates than the U.S., then we would save 9,031 lives. In addition to public health efforts leading to reductions in obesity and tobacco use, access to medical care has been an important factor in reducing mortality.