Callahan S Todd, Cooper William O
Division of Adolescent Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Pediatrics. 2007 Jun;119(6):1175-80. doi: 10.1542/peds.2006-1881.
Although considered critical to facilitate the successful transition from pediatric to adult health care, the continuity of insurance coverage for young adults with disabilities as they make the transition to adulthood has not been well characterized. The purpose of this work was to compare the continuity of insurance coverage reported by a nationally representative sample of young adults 16 to 25 years old with and without disabilities during a consecutive 36-month period.
We performed secondary analysis of data from the 2001 Survey of Income Program and Participation. Data for the survey were collected at 4-month intervals from February 2001 through January 2004 for 5170 young adults. Subjects with disabilities were those who reported limitations in activities of daily living or work, used assistive devices, and/or had learning disabilities, mental retardation, or other mental disorders. The primary outcome was uninsurance defined for each study month in which there was no coverage by private, public, or military programs. We present bivariate analyses of the months of uninsurance according to disability status using longitudinal weights and design-effect adjustments to account for the complex sample design.
The sample consisted of 599 subjects with and 4571 without reported disabilities, representing 3,970,000 and 30,800,000 young adults in the United States, respectively. At study entry, 22% of the young adults with disabilities were uninsured. During the 36-month follow-up period, 56% of the young adults with disability reported gaps in insurance coverage with a mean of 15 months of uninsurance. The proportion of uninsured subjects did not significantly differ by disability status.
The majority of young adults with disabilities reported gaps in insurance coverage, and many were uninsured for a substantial portion of the study period. As an increasing number of children with special health care needs make the transition to adulthood, improving the continuity of health insurance coverage for this population warrants specific attention.
尽管保险覆盖的连续性被认为对促进残疾青年从儿科医疗成功过渡到成人医疗至关重要，但残疾青年在步入成年期时保险覆盖的连续性情况尚未得到充分描述。本研究的目的是比较一个具有全国代表性的、年龄在16至25岁之间的残疾青年和非残疾青年样本在连续36个月期间报告的保险覆盖连续性情况。
我们对2001年收入与项目参与调查的数据进行了二次分析。该调查的数据从2001年2月至2004年1月，每4个月收集一次，共涉及5170名青年。残疾受试者是那些报告在日常生活活动或工作中有受限情况、使用辅助设备和/或有学习障碍、智力障碍或其他精神障碍的人。主要结局是在每个研究月中未被私人、公共或军事项目覆盖的无保险状态。我们使用纵向权重和设计效应调整对按残疾状况划分的无保险月数进行双变量分析，以考虑复杂的样本设计。
样本包括599名报告有残疾的受试者和4571名无残疾报告的受试者，分别代表美国397万和3080万青年。在研究开始时，22%的残疾青年未参保。在36个月的随访期内，56%的残疾青年报告有保险覆盖缺口，平均无保险时间为15个月。未参保受试者的比例在残疾状况方面无显著差异。
大多数残疾青年报告有保险覆盖缺口，并且许多人在研究期间的大部分时间里未参保。随着越来越多有特殊医疗需求的儿童步入成年期，改善这一人群的医疗保险覆盖连续性值得特别关注。
