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June 2010

More Bad News for the Uninsured—Reply

Author Affiliations

Author Affiliations: Children's Hospital Boston and Harvard Medical School (Dr Rosen), Center for Surgery and Public Health (Drs Rosen, Saleh, Lipsitz, Rogers, and Gawande), Division of Burn, Trauma, and Critical Care, Department of Surgery (Dr Rogers), and Division of General and Gastrointestinal Surgery, Department of Surgery (Dr Gawande), Brigham and Women's Hospital, and Harvard School of Public Health (Dr Gawande), Boston, Massachusetts; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles (Dr Rosen); and Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada (Dr Saleh).

Arch Surg. 2010;145(6):604-605. doi:10.1001/archsurg.2010.101

In reply

We wish to thank Drs White and Zwemer for their letter. We were as concerned as they are about lay authors interpreting our study to prove that being uninsured causes higher mortality. However, we are cognizant as researchers that while we did find a significant association, this does not establish causation. We discussed possible mechanisms for our findings, but we point out that further studies need to be performed to find out why the observed disparity exists.

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