Insurance status and health-related quality-of-life disparities after trauma: results from a nationally representative survey in the US

Qual Life Res. 2016 Apr;25(4):987-95. doi: 10.1007/s11136-015-1126-0. Epub 2015 Sep 4.


Purpose: To determine whether insurance status modifies the association between injuries and health-related quality of life (HRQOL) in a nationally representative sample of US adults.

Methods: This is a longitudinal, observational study using the pooled 2000-2006 Medical Expenditure Panel Survey (MEPS). A total of 50,225 adults (age ≥ 18) with or without injuries were included in the study. HRQOL was evaluated using the EuroQoL Health Index (EQ-5D), visual analog scale (VAS), and the SF-12 physical component score (PCS) and mental component score (MCS). A categorical variable of injury-insurance combinations was created (not injured-privately insured, not injured-publically insured, not injured-uninsured, injured-privately insured, injured-publically insured, or injured-uninsured) and was included in the linear regression models. Adjustment covariates included age, gender, education, race, diabetes, hypertension, and baseline self-reported health. Healthcare utilization was also examined among the study population by injury status and across insurance groups.

Results: Seven hundred and ten individuals reported injuries. Adjusted analyses showed that injured individuals with public insurance had lower EQ-5D (-0.25), VAS (-11.4), PCS (-8.5), and MCS (-4.9) than the privately insured controls, while uninsured had EQ-5D, VAS, PCS and MCS that were, respectively, -0.12, -7.2, -2.6 and -4.1 relative to privately insured controls. With the exception of hospital discharges, healthcare utilization among uninsured individuals was lower than those with public or private insurance.

Conclusions: We found injured individuals to have lower HRQOL than those without injuries, and this effect was exacerbated by insurance status. These findings call for interventions aimed to narrow the outcome disparity among injured in the US.

Keywords: Disparity; Health-related quality of life; Injuries; Insurance; Medical Expenditure Panel Survey.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Delivery of Health Care / economics
  • Delivery of Health Care / statistics & numerical data
  • Female
  • Health Expenditures
  • Health Literacy
  • Healthcare Disparities / economics*
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Longitudinal Studies
  • Male
  • Medically Uninsured / statistics & numerical data*
  • Middle Aged
  • Pain Measurement
  • Quality of Life*
  • Surveys and Questionnaires
  • United States
  • Wounds and Injuries / economics*
  • Wounds and Injuries / therapy*
  • Young Adult