Tuesday, January 7, 2014

Study: Looking for the uninsured in Massachusetts? Check opioid dependent persons seeking detoxification

An interesting study from Drug and Alcohol Dependence cites the rate of uninsurance at a large Massachusetts detox program as 23% in the 2013 sample they observed (five years after the insurance mandate). That's nearly five times higher than the state average of 4.8%. The authors highlight correlates of being uninsured (table below), which include being young and being male (expected), but also having a higher level of education (unexpected). Finally, more than half of the uninsured participants in the study had been so for more than one year, highlighting the ongoing need for outreach and education about public programs.

Here is the abstract via ScienceDirect:



We examined the rate of uninsurance among persons seeking detoxification at a large drug treatment program in Massachusetts in 2013, five years after insurance mandates.


We interviewed three hundred and forty opioid dependent persons admitted for inpatient detoxification in Fall River, Massachusetts. Potential predictors of self-reported insurance status included age, gender, ethnicity, employment, homelessness, years of education, current legal status, and self-perceived health status.


Participants mean age was 32 years, 71% were male, and 87% were non-Hispanic Caucasian. Twenty-three percent were uninsured. In the multivariate model, the odds of being uninsured was positively associated with years of education (OR = 1.22, 95%CI 1.03; 1.46, p < .05), higher among males than females (OR = 2.63, 95%CI 1.33; 5.20, p < .01), and inversely associated with age (OR = 0.94, 95%CI 0.90; 0.98, p < .01).


Opioid dependent persons recruited from a detoxification program in Massachusetts are uninsured at rates far above the state average. With the arrival of the Affordable Care Act, drug treatment programs in Massachusetts and nationally will be important sites to target to expand health coverage.
And here's a table from the report:

Correlates of Being Uninsured (n = 340).
CorrelateUnadjusted OR (95%CI)Adjusted OR (95%CI)
Age0.95** (0.91; 0.98)0.94** (0.90; 0.98)
Gender (Male)1.98* (1.07; 3.69)2.63** (1.33; 5.20)
Non-Hispanic Caucasian (Yes)2.48 (0.94; 6.54)2.30 (0.83; 6.41)
Homeless (Yes)0.38 (0.11; 1.29)0.33 (0.09; 1.21)
Employed Part- or Full-Time (Yes)1.09 (0.49; 2.42)0.77 (0.32; 1.89)
Education (Years)1.16* (1.01; 1.33)1.22* (1.03; 1.46)
Pending criminal charges (Yes)1.03 (0.58; 1.82)0.92 (0.51; 1.65)
Perceived Health0.71* (0.54; 0.93)0.78 (0.58; 1.05)
* p < .05, **p < .01

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