Georgia Epidemiology Report The Georgia Epidemiology Report is a publication of the Epidemiology Section of the Epidemiology and Prevention Branch, Division of Public Health, Department of Human Resources April 1996 Volume 12 Number 4 Division Of Public Health Patrick J. Meehan, M.D. - Director Epidemiology and Prevention Branch State Epidemiologist Kathleen E. Toomey, M.D., M.P.H.- Director One Million Adult Georgians Uninsured or Inadequately Insured for Health Care Epidemiology Section Paul A. Blake, M.D., M.P.H.-Director Surveillance Jeffrey D. Berschling, M.P.H.; Karen R. Horvat, M.P.H.; Jane E. Koehler, D.V.M, M.P.H.; Patrick L. Osewe, M.D., M.P.H.; Preeti Pathela, M.P.H.; Russell C. Sexton Jr., M.H.S.; Sabrina Walton, M.S.P.H. Chronic Disease Nancy E. Stroup, Ph.D.-Director Patricia M. Fox, M.P.H.; David M. Homa, Ph.D., M.P.H.; Thomas W. McKinley, M.P.H.; Edward E. Pledger, M.P.A.; D. Lee Warner, M.P.H. Tuberculosis Bharat K. Pattni, M.B.B.S., M.P.H. HIV\AIDS Awal D. Khan, Ph.D., M.A. Sexually Transmitted Diseases Quimby E. McCaskill, M.P.H.; Dhelia Williamson, M.S. Office of Perinatal Epidemiology Roger W. Rochat, M.D. - Director Mary D. Brantley, M.P.H.; Raymond E. Gangarosa, M.D., M.P.H.; Rebekah Hudgins, M.P.H.; Mary P. Mathis, Ph.D., M.P.H.; Florina Serbanescu, M.D.; Edward F. Tierney, M.P.H. Preventive Medicine Residents Lorenzo D. Botto, M.D.; Isabella A. Danel, M.D., M.S.; Hector S. Izurieta, M.D., M.P.H.;Michael M. McNeal, M.D., M.P.H.; Peter Strebel, M.D.;Sherrilyn Wainwright, M.D.; EIS Officers Luis G. Castellanos, M.D., Ph.D; Patricia M. Dietz, Dr.P.H. Georgia Epidemiology Report Editorial Board Editorial Executive Committee Patrick L. Osewe, M.D. - Editor Kathleen E. Toomey, M.D., M.P.H. Mary D. Brantley, M.P.H. Jeffrey D. Berschling, M.P.H. Mailing List Edward E. Pledger, M.P.A. During 1991-1994: q About 630,000 (15%) adult Georgians were uninsured and about 410,000 (10%) were inadequately insured each year. q 38% of uninsured adult Georgians lost their health care coverage within the last 12 months. q The majority of uninsured (63%) and inadequately insured adult Georgians (78%) were employed. This report summarizes information on the health insurance status of Georgians from 1991 through 1994. This information was collected using the Georgia Behavioral Risk Factor Surveillance System (BRFSS), a random digit-dialed telephone survey conducted each year on a representative sample of about 2,000 persons age 18 and older3. In this analysis, uninsured persons are defined as those who answered "no" when asked, "Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs (health maintenance organizations), or government plans such as Medicare?" Inadequately insured persons are defined as those with health coverage who answered "yes" when asked, "Was there a time during the last 12 months when you needed to see a doctor, but could not because of the cost?" We did not attempt to assess the adequacy of insurance for hospital services, dental care or long-term care. Adequately insured persons are defined as those with health coverage who were not limited from seeing a doctor during the last 12 months because of cost. Because Medicare covers approximately 96% of Americans aged 65 years and over, the study population was restricted to persons age 18-645. Responses were weighted so that estimates are representative of Georgia's non-elderly population. Epidemiology Section, Epidemiology & Prevention Branch, Two Peachtree St., N.W., Atlanta, GA 30303-3186 Phone: (404) 657-2588 FAX: (404) 657-2586 Results In 1991-1994, about 75% of Georgians age 18 to 64 were adequately insured, 10% were inadequately insured, and 15% were uninsured. This translates into about 410,000 inadequately insured Georgians and 630,000 uninsured Georgians each year--for a total of 1 million each year. Among the uninsured, more than one-third (38%) had been covered by a plan within the past year (Figure 1). Only 7% of uninsured persons never had any type of health care coverage. Figure 1. Length of Time Since Uninsured Georgians (18-64 years old) Last had Health Care Coverage, 1993-1994 Weighted by age distribution of Georgians 18-64 years. Source:Georgia Behavioral Risk Factor Surveillance System Not all Georgians were equally likely to be uninsured or inadequately insured. Women were more likely than men to be uninsured (16% vs. 15%) or inadequately insured (12% vs. 8%). Problems with health insurance were also more common among persons with less than $20,000 annual household income (31% uninsured and 14% inadequately insured) than among persons with more than $35,000 annual household income (6% uninsured and 7% inadequately insured) (data not shown). Table 1 presents the demographic characteristics of Georgians by health insurance coverage status. Compared to adequately insured persons, more uninsured persons were female, nonwhite, less than 30 years of age, and not married. Uninsured Georgians also had lower annual household incomes, had less than a high school education, and were less likely to be employed. Marital status and employment status were the same for inadequately and adequately insured Georgians. The distributions of race, income and education for inadequately insured persons were between those for uninsured and adequately insured persons. Seventy-eight percent of inadequately insured Georgians and 63% of uninsured Georgians were currently employed. Among all employed persons, one in five (22%) reported they either were without insurance or had insurance but could not afford medical care. Table 1. Health Insurance Coverage Reported by Georgians (18-64 years old) by Selected Demographic Characteristics, 1991-1994 Characteristic Health Insurance Status Adequate Inadequate None (n=5,115) (n=711) (n=1,003) % % % Sex Male Female 51 38* 47* 49 62 53 Race White Nonwhite 75 68* 61* 25 32 39 Age (years) 18-29 30-44 45-64 30 25* 39* 41 47 35 29 28 26 Marital status Married 62 62 43* Not married 38 38 57 Household income < $20,000 22 $20,000-$34,999 31 > $35,000 48 39* 59* 33 26 28 16 Education < 12 years 12 years > 12 years 11 18* 27* 30 36 37 59 46 35 Employment status Employed 80 78 63* Not employed 20 22 37 Weighted by age distribution of Georgians 18-64 years. * Difference between subgroup and adequately insured is statis- tically significant at p <.05 Source:Georgia Behavioral Risk Factor Surveillance System Note: Percents may not add to 100 because of rounding error Discussion These findings are based on self-reported in- formation from individuals rather than by review of insurance records. Nonetheless, these findings reveal that many Georgians believe they do not have adequate health insurance. The majority of uninsured and inadequately insured Georgians were currently employed. Na- - 2 - tional findings indicate that employer-offered health coverage is declining, particularly among smaller-sized firms5. These findings for Georgia may be a reflection of the national trend. An estimated one million Georgians lacked adequate health insurance during the early 1990's. Although cancer, cardiovascular disease, diabetes and many other conditions are treated more effectively when diagnosed early, persons without adequate insurance are more likely to delay or not seek services. Primary prevention and early detection services for certain conditions are available through local public health clinics. Editorial note In the U.S., an estimated 38.5 million (17%) persons under age 65 had no health insurance during 19922,5. Even among those who maintain insurance coverage, many were still unable to afford medical care. Of one in five (19%) Americans who reported difficulties paying their medical bills in 1992, most (75%) had some type of health insurance1. Persons may lack adequate insurance coverage for many reasons, including increasing costs of health care and health insurance1,6, changes in employment status4 and employer-provided health insurance6, loss of Medicaid eligibility4, and limitations in current policies that prohibit coverage for preexisting conditions6. Finding from this study highlight that inadequate health insurance is an important problem in Georgia. References 1) Blendon RJ, Donelan K, Hill CA, Carter W, Beatrice D, Altman D. Paying medical bills in the United States--why health insurance isn't enough. JAMA 1994; 271(12):949-51. 2) Centers for Disease Control and Prevention. Health insurance coverage and receipt of preventive health services-- United States, 1993. MMWR 1995; 44(11):219-25. 3) Frazier EL, Franks AL, Sanderson. Behavioral risk factor data. In: CDC. Using chronic disease data: a handbook for public health practitioners. Atlanta: U.S. Department of Health and Human Services, Public Health Service,CDC, 1992:4-1-4-17. 4) Marwick C. Middle class too feels loss of health insurance. JAMA 1994;271(19): 1470. 5) Snider S. Who are the medically uninsured in the United States? Statistical Bulletin--Metropolitan Insurance Companies 1994;75(2):20-30. 6) Swartz K. Dynamics of people without health insurance: don't let the numbers fool you. JAMA 1994;271(1):64-6. This report was contributed by Lee Warner, Nancy Stroup and Ed Pledger, Chronic Disease Unit, EPB, GA DPH. A Georgia Public Health Pioneer Rufus F. Payne, M.D, M.P.H., died February 18, 1995 at the Medical College of Georgia Hospital. Dr. Payne's contributions to Georgia Public Health have been enormous; he received the Sellars-McCroan Award in 1995 in recognition of his lifetime contributions to public health. Dr. Payne served in numerous public health positions during his long career including Walker County Health Director (1934-35), West Central Health District Director (1939), and Assistant Director of Fulton County Health Department (1940). In 1937, he organized a Maternal and Child Health research program in Tift County which was supported by the Children's Bureau. He was superintendent of the TB sanitarium in Alto in 1945, and founded the Battey State Hospital in Rome in 1946, where he remained as the superintendent until 1952. He left Rome to nurture the establishment of the Eugene Talmadge Memorial Hospital in conjunction with the Medical College of Georgia in Augusta where he served as superintendent until 1966. He retired from the Medical College of Georgia in 1971. He remained active in TB control, directing the program in Richmond and McDuffie counties. Even in retirement, he continued to take an active interest in the TB Control Program by forwarding notes to the state office regarding analyses of data from Augusta. He was truly a public health pioneer and will be missed by all. - 3 - The Georgia Epidemiology Report Epidemiology and Prevention Branch Two Peachtree St., NW Atlanta, GA 30303-3186 April 1996 Volume 12 Number 4 Reported Cases of Selected Notifiable Diseases in Georgia Profile for January 1996 Selected Notifiable Diseases Campylobacteriosis Giardiasis H. influenzae B Meningococcal Disease Rubella Salmonellosis Shigellosis Viral Meningitis Tuberculosis Congenital Syphilis Early Syphilis Other Syphilis Cryptosporidiosis E. coli O157:H7 Legionnaires' Disease Lyme Disease Mumps Pertussis Total Reported for January 1996 47 44 24 22 0 117 44 6 77 4 197 61 4 1 0 0 1 2 Previous 3 Months Total Ending in January 1996 1995 1994 163 228 87 119 71 105 33 11 24 46 34 26 0 0 0 355 329 236 124 533 93 31 10 18 199 215 214 16 12 19 595 601 736 220 211 189 17 6 3 3 8 5 1 12 13 0 6 9 4 0 5 6 7 10 Previous 12 Months Total Ending in January 1996 1995 1994 1010 1109 677 595 452 412 89 60 77 124 91 95 0 7 0 1677 1599 1250 1243 1978 491 104 77 160 772 771 788 56 49 111 2537 2605 3715 1064 823 983 114 19 12 27 27 15 14 110 38 14 119 52 12 15 21 30 34 56 The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office; and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia. Report Period Total Cases Reported * Percent Female AIDS Profile Update MSM Risk Group Distribution (%) IDU MSM&IDU HS Blood Unknown Race Distribution (%) White Black Other Last 12 Mos 04/95 to 03/96 5 Yrs Ago 04/90 to 03/91 Cumulative 01/80 to 03/96 2342 1289 15206 18.3 9.6 13.7 46.5 17.5 4.2 62.8 16.1 6.7 53.2 18.9 6.0 14.8 1.4 15.6 36.0 60.8 3.2 7.7 2.4 4.3 48.8 50.1 1.1 10.1 2.1 9.6 42.0 56.1 1.9 MSM - Men having sex with men IDU - Injection drug users * Case totals are accumulated by date of report to the Epidemiology Section HS - Heterosexual -4-