The Association of Health Insurance and Disease Impairment With Reported Asthma Prevalence in U.S. Children
Published Date:Oct 27 2011
Source:Health Serv Res. 47(1 Pt 2):431-445.
Adrenal Cortex Hormones
Health Services Utilization
Outcome Assessment (Health Care)
Severity Of Illness Index
Pubmed Central ID:PMC3258307
Funding:RC2 HL101811-01/HL/NHLBI NIH HHS/United States
RC2HL101811-01/HL/NHLBI NIH HHS/United States
U48 DP000056-04/DP/NCCDPHP CDC HHS/United States
To test the hypotheses that reported asthma prevalence is higher among insured than uninsured children and that insurance-based differences in asthma diagnosis, treatment, and healthcare utilization are associated with disease severity.
National Health and Nutrition Examination Survey, 2003–2008.
We used multivariate logistic regression to examine the relationship between insurance and asthma symptom severity with asthma diagnosis, treatment, and acute care utilization.
In multivariate analysis, insured children had greater odds of reporting a current diagnosis of asthma than uninsured children (Odds Ratio [OR]=2.08, 95% Confidence Interval [CI] 1.47–2.94). When interactions between insurance and asthma impairment were included, insurance was associated with greater odds of diagnosis among children with intermittent (OR=4.08, 95%CI 1.57–10.61), but not persistent, symptoms. Among children with intermittent symptoms, insurance was associated with inhaled corticosteroid use (OR=4.51, 95%CI 1.18–17.24) and asthma-related acute care utilization (OR=5.21, 95%CI 1.21–23.53); these associations were non-significant among children with persistent symptoms.
Being insured increases only the likelihood that a child with intermittent, not persistent, asthma symptoms will receive an asthma diagnosis and control medication, and may not reduce acute care utilization. Although universal insurance may increase detection and management of undiagnosed childhood asthma, theorized cost savings from reduced acute care utilization might not materialize.
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