CAMBRIDGE, MA – Nearly 45,000 annual deaths are associated with a lack of health insurance, according to the American Journal of Public Health.

The study, conducted at Harvard Medical School and the Cambridge Health Alliance and published online, found that uninsured working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from 25 percent in 1993.

“The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health,” said lead author Andrew Wilper, of the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease – but only if patients can get into our offices and afford their medications.”

The data, pulled from national surveys carried out by the Centers for Disease Control and Prevention, assessed death rates after taking into account education, income and other factors including smoking, drinking and obesity. It estimated that lack of health insurance causes 44,789 deaths annually.

Previous estimates from the Institute of Medicine and others had put that figure near 18,000.

“The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance,” said David Himmelstein, a study co-author, associate professor of medicine at Harvard Medical School and primary care physician at the Cambridge Health Alliance. “Even this grim figure is an underestimate – now one dies every 12 minutes.”

The study attributes an increase in the number of uninsured and an eroding medical safety net for the disadvantaged to the substantial increase in the number of deaths, as the uninsured are more likely to go without needed care. Another factor contributing to the widening gap is the improved quality of care for those who can get it.

Death rates were also higher for males (37 percent), current or former smokers (102 percent and 42 percent, respectively), people who said that their health was fair or poor (126 percent, and those who examining physicians said were in fair or poor health (222 percent).

“Historically, every other developed nation has achieved universal healthcare through some form of nonprofit national health insurance,” said Steffie Woolhandler, a study co-author, professor of medicine at Harvard Medical School and primary care physician at the Cambridge Health Alliance. “Our failure to do so means that all Americans pay higher healthcare costs, and 45,000 pay with their lives.”