1. Health Insurance among Hispanics in the United States: National Health Interview Survey, 1998-2000 Debra L. Blackwell, Ph.D., NCHS/DHIS LaJeana Howie, MPH, NCHS/OAEHP

2. Background Levels of non-coverage in 1997: 33% of Hispanic persons 12% of non-Hispanic white persons 19% of non-Hispanic black persons Source: 1997 NHIS Summary Statistics report on the U.S. Population

3. Research Questions Do all Hispanic subgroups have the same level of non-coverage? What characteristics are associated with a lack of health insurance coverage? Who is most likely to be uninsured?

4. National Health Interview Survey, 1998-2000 Three years of data Adults 18-64 years of age Files used: Person files –> Spouse file Family files Analyses were weighted. Sudaan was used for variance estimation.

5. Subgroups included in Analyses Mexican-Americans Puerto Ricans Cubans Other Latin Americans Multiple or non-specified Hispanics Non-Hispanic blacks Non-Hispanic whites

6. Health Insurance Coverage Status Not covered Covered Refused, Not ascertained, Don’t know

7. Non-insurance by subgroup type, NHIS, 1998-2000 Adults 18 years of age and over, age-adjusted percents

8. Immigrant-Citizenship status Not US born, not US citizen (6%) Not US born, naturalized US citizen (5%) Unknown (1%) US born, US citizen (88%) – baseline

9. Employment status Full-time/workplace insurance offered Full-time/workplace insurance not offered Full-time/workplace insurance unknown Part-time/workplace insurance offered Part-time/workplace insurance not offered Part-time/workplace insurance unknown Employment status unknown Not employed – baseline

10. Variables in adult model Subgroup type Age Sex Immigrant-citizenship status Health status Family’s health Family incomePoverty status RegionMSA Marital statusFamily size Education (own or spouse’s)Home tenure status Employment status Spouse’s workplace offers insurance coverage

11. Results CharacteristicOdds Ratio C.I. Male 1.29 (1.25, 1.33) Baseline: Females 18-30 years of age 1.83 (1.72, 1.94) 31-45 years of age 1.67 (1.59, 1.76) Baseline: Persons 46-64 years of age Divorced/Separated 1.31 (1.22, 1.39) Living with a partner 1.91 (1.77, 2.06) Baseline: Married persons

12. CharacteristicOdds Ratio C.I. Mexican-American 1.53 (1.41, 1.66) Other Latin American 1.32 (1.17, 1.49) Mult/Non-sp Hispanic 1.41 (1.24, 1.61) Non-Hispanic black 1.16 (1.09, 1.23) Baseline: Non-Hispanic white adults Language of Interview – Spanish 1.45 (1.31, 1.61) Baseline: English Not US born/not citizen 1.91 (1.77, 2.06) Baseline: US born persons

13. CharacteristicOdds Ratio C.I. Less than HS education 2.46 (2.29, 2.65) GED 2.90 (2.60, 3.25) HS Graduate 2.20 (2.05, 2.36) Some college 1.51 (1.41, 1.62) Baseline: Persons with a college degree

14. CharacteristicOdds Ratio C.I. Near poor 1.40 (1.30, 1.51) Baseline: Not poor persons Less than $20,000 2.70 (2.41, 3.03) $20,000-$34,999 2.55 (2.36, 2.76) $35,000-$54,999 1.73 (1.60, 1.87) Baseline: Persons w/ family incomes equal/above $55,000

15. CharacteristicOdds Ratio C.I. Person in fair health 0.81 (0.75, 0.88) Person in poor health 0.51 (0.45, 0.58) Baseline: Persons in excellent health 1+ family members in fair/poor health 1.23 (1.12, 1.36) Baseline: Persons in families whose members are in good/very good/excellent health

16. CharacteristicOdds Ratio C.I. Emp FT, wrkplace ins offered 0.23 (0.22, 0.25) Emp FT, wrkplace ins not offered 2.59 (2.46, 2.73) Emp PT, wrkplace ins offered 0.43 (0.39, 0.47) Emp PT, wrkplace ins not offered 1.47 (1.39, 1.56) Baseline: Non-employed persons

17. CharacteristicOdds Ratio C.I. Spouse’s wrkplace offers ins 0.34 (0.32, 0.36) Spouse’s wrkplace does not offer ins 1.50 (1.42, 1.59) Baseline: Unmarried persons South region 1.65 (1.54, 1.77) West region 1.22 (1.12, 1.32) Baseline: Persons residing in the Northeast

18. CharacteristicOdds Ratio C.I. Mexican male, emp FT, no wrkplace ins 1.86 (1.64, 2.11) Baseline: All other persons (except Otr LA males, working FT, no wrkplace ins offered) Otr LA male, emp FT, no wrkplace ins 1.65 (1.35, 2.02) Baseline: All other persons (except Mexican-American males, working FT, no wrkplace ins offered)

19. Conclusions Cubans and Puerto Ricans no more likely than non-Hispanic white adults to lack health insurance coverage Mexican Americans, Other Latin Americans, and Hispanics who did not specify a particular origin or specified multiple Hispanic origins significantly more likely than non-Hispanic whites to lack coverage Introduction of relevant controls does not “explain away” this effect.

20. Where to get more info about the NHIS…. NHIS web-site: http://www.cdc.gov/nchs/nhis.htm To join the NHIS listserve: go to http://www.cdc.gov/subscribe.html and follow instructions.