A National Health and Nutritional Examination Survey (1999 - 2004) of more than 12,000 patients aged 18 to 64 concluded that an estimated 11.4 million americans with chronic medical conditions, such as cardiovascular disease, hypertension, and diabetes, were uninsured.

The survey found that chronically ill patients without insurance were less likely than those with coverage to report a physician visit within the last 12 months and more likely to report using an emergency department as a standard site for care.

The authors estimated that nearly one-third of unisured U.S. adults had at least one chronic condition. However, authors say that given the limited access to care among those without insurance, undiagnosed conditions in this population may be common.

The authors call for advocacy focused on expansion of health insurance coverage, as lack of health insurance is strongly associated with poor access to care.

Annals of Internal Medicine is one of the five most widely cited peer-reviewed medical journals in the world. The journal has been published for 81 years and accepts only 7 percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians (ACP), the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.

American College of Physicians