2M Research, LLC Contractor to Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
J Asthma. 2020 Oct;57(10):1103-1109. doi: 10.1080/02770903.2019.1640730. Epub 2019 Jul 25.
Children with asthma have ongoing health care needs and health insurance is a vital part of their health care access. Health care coverage may be associated with various cost barriers to asthma care. We examined cost barriers to receiving asthma care by health insurance type and coverage continuity among children with asthma using the 2012-2014 Child Asthma Call-back Survey (ACBS). The study sample included 3788 children under age 18 years with current asthma who had responses to the ACBS by adult proxy. Associations between cost barriers to asthma care and treatment were analyzed by demographic, health insurance coverage, and urban residence variables using multivariable logistic regression models. Among insured children, more blacks reported a cost barrier to seeing a doctor (10.6% [5.9, 18.3]) compared with whites (2.9% [2.1, 4.0]) ( = 0.03). Adjusting for demographic factors (sex, age, and race), uninsured and having partial year coverage were associated with cost barrier to seeing a doctor (adjusted prevalence ratio aPR = 8.07 [4.78, 13.61] and aPR = 6.58 [3.78, 11.45], respectively) and affording medication (aPR = 8.35 [5.23, 13.34] and aPR = 4.93 [2.96, 8.19], respectively), compared with children who had full year coverage. Public insurance was associated with cost barrier to seeing a doctor (aPR = 4.43 [2.57, 7.62]), compared with private insurance. Having no health insurance, partial year coverage, and public insurance were associated with cost barriers to asthma care. Improving health insurance coverage may help strengthen access to and reduce cost barriers to asthma care.
患有哮喘的儿童有持续的医疗保健需求，而健康保险是他们获得医疗保健的重要组成部分。健康保险的覆盖范围可能与哮喘护理的各种费用障碍有关。我们使用 2012-2014 年儿童哮喘回拨调查（ACBS），根据健康保险类型和哮喘治疗连续性，检查哮喘护理的费用障碍。研究样本包括 3788 名年龄在 18 岁以下的当前患有哮喘的儿童，这些儿童通过成人代理对 ACBS 做出了回应。使用多变量逻辑回归模型，根据人口统计学、健康保险覆盖范围和城市居住情况，分析哮喘护理和治疗费用障碍之间的关联。在有保险的儿童中，与白人（2.9%[2.1, 4.0]）相比，更多的黑人报告看医生存在费用障碍（10.6%[5.9, 18.3]）（ = 0.03）。调整人口统计学因素（性别、年龄和种族）后，未参保和部分年度参保与看医生的费用障碍相关（调整后的患病率比 aPR = 8.07[4.78, 13.61]和 aPR = 6.58[3.78, 11.45]），以及药物负担（aPR = 8.35[5.23, 13.34]和 aPR = 4.93[2.96, 8.19]），与拥有全年保险的儿童相比。与私人保险相比，公共保险与看医生的费用障碍相关（aPR = 4.43[2.57, 7.62]）。没有健康保险、部分年度保险和公共保险与哮喘护理的费用障碍有关。提高健康保险的覆盖范围可能有助于加强对哮喘护理的获得并降低其费用障碍。
