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Indicator Details: Percentage of Residents <65 with CKD Reporting Having Health Insurance
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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 MeasureAdequacy of insurance coverage
Data SourceNCHS
Type of Data SourcePublic
Health Care System DataNo
Regional or National?National
Demographic GroupNon-institutionalized U.S. residents <65 years old
NumeratorParticipants 20-64 years old reporting having insurance
DenominatorParticipants 20-64 years old completing health insurance questionnaire portion of survey
Definition of CKDeGFR <60 ml/min/1.73 m²
Glomerular filtration rateEstimated 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 Indicatorhiq011/hid010: covered by any insurance
Primary Indicator Method of MeasurementQuestionnaire (interviewer-administered)
Secondary (1) Variablehid030A-E/hiq031A-J: type of insurance
Secondary (1) Indicator Method of MeasurementQuestionnaire (interviewer-administered)
Secondary (2) Variablehiq210: period of non-coverage in last year?
Secondary (2) Indicator Method of MeasurementQuestionnaire (interviewer-administered)
U.S. Region Covered by Primary VariableAll
Period Currently Available1999–2016
Pending Data2017-2018
Additional Data Items of InterestSurvey year, other stratification variables of interest (age, gender, race/ethnicity, diabetes by self-report, hypertension by self-report)
Limitations of IndicatorSelf-report only
Analytic ConsiderationsAppropriate 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.”

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd