MORTAL RISK; or How Science Can Be Manipulated For Ideology

Douglas Thompson has an excellent takedown of a study published in the American Journal of Public Health (AJPH) in December 2009. The statistical analysis of the study concludes that the uninsured have higher annual death rates than the insured, and it was widely heralded as evidence that Health Care Reform is necessary to prevent these deaths. From "How 4 Deaths Became 401,309":

Co-author Dr. David Himmelstein of Harvard Medical School proclaims in an interview with CNN that for those without health insurance, "it means that you're at mortal risk." Many news outlets discussed this study, with reports of 45,000 deaths annually being linked to lack of health insurance.

Thompson then carefully and systematically analyzes the data sets and discoveres that:

Insurance status has little to no impact on participants who die violently, as these persons would get emergency care, which is not dependent on heath insurance. If the four excess deaths we identified were from violent causes, there would be no underlying correlation between insurance status and early death.

We can identify forty persons who died from motor vehicle accidents (ICD-10 code 114) in the NHANES III study (participants #646, #1107, #1475, #2441, #2528, #3384, #3859, #3867, #4111, #5257, #9786, #10504, #12302, #12980, #13419, #13553, #16145, #16862, #18014, #18936, #19288, #19695, #19858, #33112, #33661, #36565, #39275, #40308, #42863, #43194, #43438, #46507, #46882, #47250, #47905, #49168, #49472, #51896, #52206 and #53476). The availability of insurance would have had little impact.

We can also identify eleven persons who died from suicide by firearm (ICD-10 code 125 -- participants #3947, #6138, #10655, #14336, #15860, #18222, #37902, #42061, #47057, #48163 and #48495). Health insurance would likely have had little impact on their deaths, either.

Statistical studies are onerous. The researchers of this study used the best available tools in very valid methods. Researchers must take into account that when looking at such small subsets of data (four additional deaths in nine years), claims of "mortal risk" become more difficult to ascertain regarding the population of the U.S. as a whole. Wilper, et al. should discount deaths from violent causes before making claims on the correlation of death and health insurance, especially when the net difference in deaths between the insured and uninsured groups is likely only four deaths during a nine-year study.

Please read it all.

I happen to agree with the co-author of the study: America is at mortal risk--but not because of a lack of universal health coverage. We are at risk because ideologues will use lies, damn lies and statistics and call their dubious conclusions "science" in order to advance an ideology. Like the global warming 'science' issue, causation cannot be implied from correlation; nor is it valid to ignore the question of how the people in the study died (as Thompson points out). Statistical methodology may be applied perfectly correctly and appropriately; but that doesn't mean that the data sets they are used on are valid to begin with.