The uninsured populace in this country is more likely to suffer from chronic disease and aliments that could be easily manageable if they had greater access to treatments and care according to a recent study completed by Harvard University (Cambridge, Massachusetts) researchers.

It's a vicious cycle, causing easily manageable diseases such as hypertension and diabetes, to develop into deadlier diseases such as stroke that require more costly care, according to researchers.

"There are very real and serious consequences when these conditions go untreated," Andrew Wilper MD, a lead author of the study told Medical Device Daily. "Ultimately we determined that the uninsured suffered even more than the insured when it came to dealing with chronic illnesses."

The study was published yesterday in Health Affairs and looked at data from a recent national survey conducted by the Centers for Disease Control and Prevention. The researchers, based at Harvard Medical School and the affiliated Cambridge Health Alliance, looked at data on 15,976 U.S. non-elderly adults from the National Health and Nutrition Examination Survey (NHANES), between 1999 and 2006.

The study was retrospective and it asked respondents to answer detailed questions about their health and economic circumstances. The researchers then examined the participants and ordered laboratory tests.

Wilper and the group found through the study, that nearly half of all uninsured people with diabetes (46%) or high cholesterol (52%). In contrast, about one-quarter of those with insurance were unaware of their illnesses (23 % for diabetes, 29.9 % for high cholesterol).

Undertreatment of disease followed similar patterns, with the uninsured being more likely to be undertreated than their insured counterparts: 58.3% vs. 51.4 % had their high blood pressure poorly controlled, and 77.5% vs. 60.4 % had their high cholesterol inadequately treated.

The report also said that being insured was not associated with a widely used measure of diabetes control (a hemoglobin A1c level below 7), a finding the authors attribute to the stringent definition of good diabetes control used in the NHANES survey.

Even with excellent medical care, many diabetics fail to achieve such low hemoglobin A1c levels. Using less stringent hemoglobin A1c thresholds of 8 and 9, uninsured adults had significantly worse blood sugar control than their insured counterparts, the researchers found.

Wilper said the results revealed some serious consequences the uninsured face.

Referring to a study released in the American Journal of Public Health last month, which has been widely quoted by Sen. Max Baucus (D-Montana) and others, Wilper said "Our previous work demonstrated 45,000 deaths annually are linked to lack of health insurance. Our new findings suggest a mechanism for this increased risk of death among the uninsured. They're not getting life-saving care."

This is one of many studies in recent months that Wilper and some of his team have taken part in. About three months ago two members of the group David Himmelstein MD and Steffie Woolhandler MD, released a study showing how taxing job-based health benefits would adversely affect low income families (Medical Device Daily, Aug. 24, 2009).

Last year, the group released a study analyzing the 11 million Americans with chronic physical illnesses that weren't getting the medical care they needed because of a lack of health insurance. The authors of the study said that this is one of the first real studies that provides a national estimate of the number of uninsured adults with these potentially serious but treatable conditions (MDD, Aug. 8, 2008).

Discussing the lack of healthcare options in this country is a passion of Wilper, who has been closely following the healthcare debate.

Although he is encouraged by the current debate he said that the solutions being presented at the time don't hit the true heart of the issue and are "half measures" at best. He said this current study alone should shine some light onto what needs to be done with healthcare reform.

"Our study should lay to rest the myth that the uninsured can get the care they need," Wilper said. "Millions have serious chronic conditions and don't even know it. And they're not getting care that would prevent strokes, heart attacks, amputations and kidney failure."

Omar Ford, 404-262-5546;