Among adults aged 20-64 years with CKD (eGFR <60 ml/min/1.73 m²), Mexican-Americans had the lowest self-report of health insurance (80%) relative to Non-Hispanic whites (93%) and Non-Hispanic blacks (88%).
Chart Explanation: While a large proportion of those with CKD were covered by insurance in 2011-2016 (90.6%), those of Mexican-American race/ethnicity (79.8%) were less likely to report being insured than their counterparts (93.2% and 88.1% among Non-Hispanic whites and blacks, but were not significantly different from these groups P=0.06 by χ²). When looking at age and gender, there were minimal differences observed. During 2011-2016, the percentages of U.S. residents aged 20-64 years with CKD reporting various types of insurance were: private insurance, 65.0%; Medicare, 19.4%; Medicaid/SCHIP, 23.3%; other government coverage (e.g., Veterans Affairs or Indian Health Service), 10.1%; and single-service plans, 7.1%. (Note participants could report more than one type of insurance.)
The NHANES (National Health and Nutrition Examination Survey) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents.
The uninsured are at risk for poor outcomes due to lack of affordable access to both preventive and chronic disease care. The NHANES surveys are currently conducted every 2 years by the CDC's National Center for Health Statistics to examine disease prevalence and trends over time in different cross-sectional representative samples of noninstitutionalized U.S. civilian residents. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here, we examined data on self-reported insured status from 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, and 2015-2016 NHANES surveys. Participants aged 65 or older were excluded due to nearly complete (96.9%) insurance coverage (by Medicare) in this population.
|Description of Measure||Adequacy of insurance coverage|
|Type of Data Source||Public|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Non-institutionalized U.S. residents <65 years old|
|Numerator||Participants 20-64 years old reporting having insurance|
|Denominator||Participants 20-64 years old completing health insurance questionnaire portion of survey|
|Definition of CKD||eGFR <60 ml/min/1.73 m²|
|Glomerular filtration rate||Estimated using MDRD Study equation for calibrated creatinine: eGFR=175 × [(calibrated serum creatinine in mg/dl)-1.154] × age-0.203 × (0.742 if female) × (1.210 if African-American)|
|Primary Data Source Indicator||hiq011/hid010: covered by any insurance|
|Primary Indicator Method of Measurement||Questionnaire (interviewer-administered)|
|Secondary (1) Variable||hid030A-E/hiq031A-J: type of insurance|
|Secondary (1) Indicator Method of Measurement||Questionnaire (interviewer-administered)|
|Secondary (2) Variable||hiq210: period of non-coverage in last year?|
|Secondary (2) Indicator Method of Measurement||Questionnaire (interviewer-administered)|
|U.S. Region Covered by Primary Variable||All|
|Period Currently Available||1999–2016|
|Additional Data Items of Interest||Survey year, other stratification variables of interest (age, gender, race/ethnicity, diabetes by self-report, hypertension by self-report)|
|Limitations of Indicator||Self-report only|
|Analytic Considerations||Appropriate NHANES survey weights must be used for all analyses (MEC if MEC-examined variables used); if SE 30% or more of estimate, must report as “low precision.”|