Zhang Xing, Lemon Tiffany L
College of Health Solutions, Arizona State University, Phoenix, Arizona.
College of Health Solutions, Arizona State University, Phoenix, Arizona.
Am J Prev Med. 2025 Feb;68(2):257-263. doi: 10.1016/j.amepre.2024.10.002. Epub 2024 Oct 9.
Although health insurance is a critical tool for well-being across the life course, few studies have explored the long-term health implications of shifts in insurance coverage. This study examined whether changes in insurance types from adolescence to early midlife were associated with early midlife self-rated health.
This study used data from Wave I (1994-1995; average age 15.7 years), Wave IV (2008-2009; average age 28.7 years), and Wave V (2016-2018; average age 37.6 years) of Add Health, including 6,765 respondents from 1994 to 2018. Logistic regression was used to examine the association between health insurance status from adolescence to early midlife and early midlife self-rated health. The analyses were conducted from March to August 2024.
Relative to having private insurance in adolescence and early midlife, the following health insurance statuses in adolescence and early midlife were significantly associated with poorer early midlife self-rated health: public in adolescence and early midlife (AOR=3.34; 95% CI=1.89, 5.91); uninsured in adolescence to public at early midlife (AOR=3.29; 95% CI=1.85, 5.85); private in adolescence to public at early midlife (AOR=3.36; 95% CI=2.46, 4.58), and private in adolescence to uninsured at early midlife (AOR=1.68; 95% CI=1.10, 2.55).
Health insurance statuses from adolescence to early midlife, specifically having or switching into public insurance, may be associated with poorer health in early midlife among individuals who were adolescents in the early 1990s. More research is needed to explore how insurance reform such as the Children's Health Insurance Program may have mitigated this association in future cohorts.
尽管健康保险是贯穿人生各阶段保障福祉的关键工具，但很少有研究探讨保险覆盖范围变化对长期健康的影响。本研究调查了从青春期到中年早期保险类型的变化是否与中年早期的自评健康状况相关。
本研究使用了“青少年健康与生活经历研究”（Add Health）第一波（1994 - 1995年；平均年龄15.7岁）、第四波（2008 - 2009年；平均年龄28.7岁）和第五波（2016 - 2018年；平均年龄37.6岁）的数据，包括1994年至2018年的6765名受访者。采用逻辑回归分析来研究从青春期到中年早期的健康保险状况与中年早期自评健康之间的关联。分析于2024年3月至8月进行。
与在青春期和中年早期都拥有私人保险相比，以下青春期和中年早期的健康保险状况与中年早期较差的自评健康显著相关：青春期和中年早期均为公共保险（比值比[AOR]=3.34；95%置信区间[CI]=1.89, 5.91）；青春期无保险到中年早期为公共保险（AOR=3.29；95% CI=1.85, 5.85）；青春期为私人保险到中年早期为公共保险（AOR=3.36；95% CI=2.46, 4.58），以及青春期为私人保险到中年早期无保险（AOR=1.68；95% CI=1.10, 2.55）。
从青春期到中年早期的健康保险状况，特别是拥有或转为公共保险，可能与20世纪90年代初处于青春期的个体在中年早期的健康状况较差有关。需要更多研究来探索诸如儿童健康保险计划等保险改革如何在未来队列中减轻这种关联。
