Cedars-Sinai Blog

Study: Health Insurance Could Be a Matter of Life and Death

Primary Care At Health FairHow big a difference can insurance make?

It could make you 17% less likely to die of a cardiac arrest.

And since cardiac arrest—a sudden electrical malfunction in the heart that disrupts its rhythm—kills 90% of its victims, that difference is significant.

Sudden cardiac arrest declined significantly among previously uninsured adults who acquired health insurance through the Affordable Care Act (ACA), also known as Obamacare, according a study published in the Journal of the American Heart Association.

The study—an effort between researchers at Cedars-Sinai and Oregon Health & Science University—shows that health insurance can affect health outcomes. The findings were based on an analysis of emergency medical services in an urban Oregon county before and after the insurance expansion mandated by the ACA.

"Health insurance allows people to engage in regular medical care, which is crucial for the prevention of cardiovascular disease and the diagnosis and treatment of conditions that can cause cardiac arrest."

The study found that among previously uninsured adults 45-64, the incidence of cardiac arrest decreased by 17%. The incidence remained the same among adults over age 65, a group that had consistently high rates of health insurance coverage before and after the ACA, primarily through Medicare.

"Cardiac arrest is a devastating and under-recognized cause of premature death for both men and women age 45 and older," said Dr. Eric Stecker, associate professor of cardiology at Oregon Health & Science University's Knight Cardiovascular Institute in Portland, Oregon, and the study's lead author. "Health insurance allows people to engage in regular medical care, which is crucial for the prevention of cardiovascular disease and the diagnosis and treatment of conditions that can cause cardiac arrest."

More than 350,000 out-of-hospital cardiac arrests happen every year in the US. The terms "sudden cardiac arrest" and "heart attack" are often used interchangeably, but the conditions are vastly different.

Cardiac arrest is an electrical disturbance in the heart that causes the heart to stop beating. It often happens with little or no warning, and usually leads to death immediately. Heart attacks happen when one of the arteries leading to the heart becomes clogged, disrupting blood flow to the heart muscle.

"Because so few survive a sudden cardiac arrest, it is imperative that we be able to predict which patients are the most vulnerable," said the study's senior author, Dr. Sumeet Chugh, director of the Heart Rhythm Center at the Cedars-Sinai Smidt Heart Institute. "Effective primary prevention is the only way to make a significant impact on this problem. Fewer than 10% of these patients are going to make it out of the hospital alive. By the time we dial 911, it's much too late for most of them."

"Because so few survive a sudden cardiac arrest, it is imperative that we be able to predict which patients are the most vulnerable. Effective primary prevention is the only way to make a significant impact on this problem."

The findings published today came out of a larger research enterprise, called the Oregon Sudden Unexpected Death Study, a comprehensive, 16-hospital, multiyear assessment of cardiac deaths in the Portland metropolitan area. The study, led by Dr. Chugh, has been underway for more than a decade. Data collected from it provides Dr. Chugh and his team with unique, community-based information to mine for answers about what causes sudden cardiac arrest.

Researchers examined records for emergency medical services in Multnomah County, Oregon, to identify patients with out-of-hospital cardiac arrest. They compared this information to US Census Bureau data for the county's adult population in the years before ACA implementation (2011-2012) and after the law took effect (2014-2015).

The investigators caution that although the study shows a strong association between health insurance and lower rates of cardiac arrest, it does not prove cause and effect. If larger studies among more diverse groups of patients confirm these findings, that would potentially have major public health implications, the authors say.

"It is crucial to more comprehensively identify the health benefits of insurance and to carefully consider public policies that affect the number of uninsured Americans," Dr. Stecker said.

The National Heart Lung and Blood Institute funded the study.