Advance directives (Medical care); Health insurance; Medically uninsured persons


Background: The relationship between advance directive (AD) completion and health insurance status is rarely studied.

Method: AD completion information was collected through the 2008 Nevada Behavior Risk Factor Surveillance System (BRFSS), a statewide cross-sectional telephone survey. Nevada non-institutionalized population over 18 were randomly selected as a population sample. Respondents were divided to “health care plan group” (HCPG) and “no health care plan group” (NHCPG). Demographic and behavior risk factors were also collected. Weighted multiple logistic regressions were utilized to assess the relationships between ADs, healthcare coverage and other factors.

Results: Of 4,461 respondents completing the survey, HCPG were six times more likely to have completed an AD than the NHCPG (unadjusted odds ratio: 6.08, 95% CI: 4.34-8.51). After controlling for demographic factors, the HCPG were still more than twice as likely to have completed an AD as NHCPG (AOR = 2.67, 95% CI:1.80-3.97). Only slight differences emerged for AD completion between HPCG and NHCPG when health status (AOR = 2.74, 95% CI, 1.81-4.14) and health behaviors (AOR = 2.63, 95% CI: 1.73-3.98) were added to the model.

Conclusion: Health insurance, after age and college education, is the third strongest predictor of AD completion.