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The authors ask you:
Background: Recent estimates from the National Health Interview Survey (NHIS) suggest that more than 53 million Americans were uninsured for at least part of the previous year in 2007. Hispanic workers appear to be particularly at risk for never obtaining or losing health insurance coverage. The current study examined a 9-year trend in health insurance coverage by occupation type, industrial sector, and race-ethnic category.
Approach: Data from the 1997-2006 NHIS were analyzed. The weighted prevalence and standard error of health insurance coverage were computed for each year by race-ethnic worker subpopulation. Multivariate analyses examined prevalence of coverage by subgroup (e.g., race/ethnicity, gender).
Results: Average rates of health insurance coverage over the 9 year period were significantly higher among Non-Hispanic White and Non-Hispanic Black workers (88% for Whites; 81% for Blacks) compared to only 62% of Hispanic workers.
Conclusions: Overall rates of health insurance coverage
in US Workers declined over the past decade – particularly among non-unionized
professions (e.g., Construction) and for Hispanic workers overall.
Future directions: Policy makers and researchers should expect increased
health burden due to the lack of health insurance among US workers and their
families.
Recent 2007 estimates of health insurance coverage report that more than 53 million Americans were uninsured for at least part of the previous year. The high cost of health insurance coupled with employment-related circumstances (such as changed/lost job, self-employment, and lack of access to employer-offered health insurance) are by far the two most common factors cited when Americans are asked why they lack health insurance. Other evidence suggests that language barriers for Spanish-speaking workers may also play an important role in the lack of employer-sponsored health insurance. To explore this further, we sought to determine if declining health insurance coverage among U.S. workers – and Hispanic workers in particular – varied according to the type of occupation and by industrial sector using the most recent data from the National Health Interview Survey (NHIS).
| Average Yearly | Percent with Health Insurance | % | Regression | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Observed | Population | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | Down | Slope±SE | p | |
| Race/Ethnicity | |||||||||||||||
| NH White | 12191 | 9355201 | 88.3 | 89.5 | 89.5 | 88.5 | 88.8 | 88.6 | 88.0 | 87.6 | 87.5 | 86.4 | 2.1 | -0.23 ± 0.05 | <0.001 |
| NH Black | 2484 | 1373873 | 81.9 | 81.2 | 82.3 | 80.4 | 81.6 | 82.5 | 80.8 | 80.0 | 78.7 | 79.0 | 3.6 | -0.29 ± 0.13 | 0.039 |
Hispanic |
3176 | 1485853 | 66.0 | 65.8 | 66.0 | 61.7 | 63.2 | 62.9 | 60.3 | 58.7 | 59.0 | 58.1 | 12.0 |
-0.97 ± 0.15 | <0.001 |
| Hispanic Gender | |||||||||||||||
| Male | 1716 | 901618 |
62.1 | 62.0 | 61.6 | 56.4 | 57.9 | 58.2 | 56.2 | 54.5 | 54.2 | 51.7 | 16.8 | -1.10 ± 0.14 | <0.001 |
| Female | 1459 | 584235 |
72.2 | 71.6 | 72.6 | 69.4 | 70.7 | 69.5 | 67.0 | 65.7 | 66.9 | 68.1 | 5.7 | -0.70 ± 0.14 | <0.001 |
| Hispanic NCHS Occupational Group1 | |||||||||||||||
| White Collar | 991 | 445684 | 80.8 | 81.2 | 83.8 | 79.1 | 79.3 | 82.6 | 76.9 | 79.3 | 80.2 | 77.3 | 4.3 | -0.44 ± 0.19 | 0.025 |
| Service Groups | 527 | 233298 | 54.9 | 51.6 | 50.1 | 49.0 | 50.3 | 50.8 | 50.3 | 49.3 | 49.6 | 54.2 | 1.3 | -0.33 ± 0.30 | 0.276 |
| Farm Workers | 126 | 58783 | 34.3 | 43.8 | 33.3 | 34.2 | 41.6 | 32.1 | 30.3 | 39.4 | 33.7 | 30.3 | 11.7 | -0.15 ± 0.44 | 0.742 |
| Blue Collar | 833 | 408701 | 60.3 | 55.2 | 58.5 | 56.1 | 54.1 | 54.0 | 53.7 | 47.5 | 49.9 | 48.1 | 20.3 |
-1.48 ± 0.22 | <0.001 |
| Hispanic NIOSH NORA Industrial Sector1,2 | |||||||||||||||
| Ag, Forest, Fish | 146 | 68451 |
32.2 | 39.1 | 30.9 | 29.9 | 39.0 | 28.7 | 33.9 | 38.9 | 33.7 | 24.1 | 25.2 | -0.22 ± 0.46 | 0.635 |
| Construction | 316 | 168062 |
47.9 | 39.6 | 43.2 | 37.6 | 42.7 | 37.0 | 37.3 | 32.3 | 30.3 | 29.5 | 38.3 | -1.69 ± 0.37 | <0.001 |
| Health and Social | 330 | 132448 |
79.0 | 74.4 | 78.4 | 77.9 | 80.5 | 78.5 | 74.5 | 76.6 | 71.8 | 77.9 | 1.4 | -0.33 ± 0.30 | 0.275 |
| Manufacturing | 468 | 222186 |
69.2 | 70.4 | 75.7 | 72.4 | 67.7 | 70.4 | 69.3 | 67.3 | 72.0 | 64.0 | 7.4 | -0.36 ± 0.29 | 0.218 |
| Services | 1071 | 493921 |
74.3 | 73.8 | 72.0 | 67.4 | 71.0 | 70.1 | 69.5 | 66.6 | 61.6 | 63.4 | 14.6 | -1.25 ± 0.25 | <0.001 |
| Transport, Warehouse, Utility | 181 | 87797 |
80.9 | 75.7 | 77.3 | 80.1 | 73.7 | 78.6 | 78.4 | 75.4 | 69.9 | 70.6 | 12.7 | -0.89 ± 0.37 | 0.021 |
| Wholesale - Retail | 607 | 282059 |
56.3 | 56.6 | 57.3 | 52.1 | 53.9 | 57.0 | 49.8 | 51.9 | 62.6 | 57.5 | -2.2 |
-0.01 ± 0.33 | 0.986 |
| 1The average yearly observed
and population estimates may not be accurate for the NCHS occupational
and NIOSH NORA industrial groups because the sample was not stratified
on these categories. 2Too few observations in Mining sector. |
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Data from the 1997-2006 National Health Interview Survey, an annual population based survey of the entire US civilian population, were analyzed (6). Employed respondents age 18 years and older reported on their occupation for the week prior to interview and whether or not anyone in the family had health insurance over the prior 12 months. This permitted a classification based on 2000 US Census Codes using a four-category occupational status variable commonly employed by the NCHS which included the categories of white-collar; service workers; farming, fishing, and forestry; and blue-collar workers. We also grouped workers into eight industrial sector classifications which are now the focus of the National Occupational Research Agenda (NORA) at the National Institute on Occupational Safety and Health (NIOSH). The prevalence and standard error of health insurance were computed for each year for Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanics. Then for Hispanics only, the prevalence and standard error of health insurance were computed for each year for subgroups based on gender, NIOSH NORA industrial sectors, and NCHS occupational categories. The SAS survey frequency procedure (SURVEYFREQ) was used to apply the appropriate weights and adjustments for the complex sampling design of the NHIS. The SAS general linear model procedure (GLM) was used to fit a separate slopes and intercepts linear regression of health insurance prevalence on year for each subgroup (i.e., race/ethnicity, gender, etc).
The mean annual sample size for the combined population of the three race/ethnicity subgroups (Non-Hispanic White, Non-Hispanic Black, and Hispanic) was 17,851, representing an annual average of 12,214,927 US workers from 1997-2006. For Hispanic workers, the annual average sample was 3,176, which represented a population of 1,485,853 US Hispanic workers. On average, Non-Hispanic White and Black workers reported having more than 80% coverage (88% for Whites; 81% for Blacks) compared to only 62% of Hispanic workers (p<0.001). These health insurance coverage rates leave an average of approximately 1,122,624 Non-Hispanic Whites, 261,036 Non-Hispanic Blacks, and 564,624 Hispanics uninsured annually. Within the NCHS categories, the average prevalence of health insurance for Hispanic white collar workers (79%) was significantly higher than for blue collar (54%), service workers (52%), and farm workers (34%) (p<0.001). Within the NIOSH NORA Industrial Sectors, there were marked differences among some of the groups in the average prevalence of health insurance coverage. The proportion of Hispanic construction and service workers who lost their health insurance was about 3-4 times greater than most of the other Hispanic workers. An examination of the trends from 1997 to 2006 for all subgroups revealed that all trends were negative, indicating that the number of uninsured US workers increased every year during that period, particularly for Hispanic workers.
This nationally representative sample of all U.S. workers illustrates the significant recent decrease in all US worker health insurance coverage. While the rate of decrease was most pronounced in blue-collar, typically non-unionized professions (e.g., Construction) and for Hispanic workers overall, the absolute number of workers annually dropping or losing health insurance was also significant even among traditionally unionized and highly skilled workers (e.g., Precision production). Loss of health insurance has serious implications not only for the individual U.S. worker, but also for their families. For example, lack of health insurance has been shown to reduce the use of preventive health care services in adults and in their children. This is an important concern among the Hispanic population, which tends to have a greater incidence of certain chronic illnesses than Non-Hispanic Whites or Blacks.
Policy makers and researchers should expect increased health burden due to the lack of health insurance among US workers and their families, particularly among Hispanic Workers and their families. The workplace could serve as a location for the delivery of preventative care and screening particularly for high risk worker populations.
Acknowledgements
Study Website at www.rsmas.miami.edu/groups/niehs/niosh; photographs provided
by Dr David Parker MD MPH; funding provided by NIOSH Grant R01 0H03915.
The findings and conclusions in this poster are those of the author(s) and do not necessarily represent the views of the National Institute for Occupational Safety and Health. Citations to Web sites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these Web sites.
