The Association of Health Insurance and Disease Impairment with Reported Asthma Prevalence in U.S. Children

Authors

  • Tumaini R. Coker M.D., M.B.A.,

    Assistant Professor, Corresponding author
    1. UCLA/RAND Center for Adolescent Health Promotion, Department of Pediatrics, David Geffen School of Medicine and Mattel Children's Hospital, University of California, Los Angeles, CA
    2. The RAND Corporation, Santa Monica, CA
    • David Geffen School of Medicine at UCLA, UCLA/RAND Center for Adolescent Health Promotion, Los Angeles, CA
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  • Robert M. Kaplan,

    1. UCLA/RAND Center for Adolescent Health Promotion, Department of Health Services, School of Public Health, University of California, Los Angeles, Los Angeles, CA
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    • Dr. Kaplan is now Director of the Office of Behavioral and Social Sciences Research (OBSSR) at NIH.
  • Paul J. Chung M.D., M.B.A.

    1. UCLA/RAND Center for Adolescent Health Promotion, Department of Pediatrics, David Geffen School of Medicine and Mattel Children's Hospital, University of California, Los Angeles, CA
    2. The RAND Corporation, Santa Monica, CA
    3. UCLA/RAND Center for Adolescent Health Promotion, Department of Health Services, School of Public Health, University of California, Los Angeles, Los Angeles, CA
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Address correspondence to Tumaini R.Coker, M.D., M.B.A., Assistant Professor, David Geffen School of Medicine at UCLA, UCLA/RAND Center for Adolescent Health Promotion, 10960 Wilshire Blvd, Suite 1550, Los Angeles, CA 90024; e-mail: tcoker@mednet.ucla.edu.

Abstract

Objective

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 health care utilization are associated with disease severity.

Data Sources

National Health and Nutrition Examination Survey, 2003–2008.

Study Design

We used multivariate logistic regression to examine the relationship between insurance and asthma symptom severity with asthma diagnosis, treatment, and acute care utilization.

Principal Findings

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 nonsignificant among children with persistent symptoms.

Conclusion

Being insured increases only the likelihood that a child with intermittent, not persistent, asthma symptoms will receive an asthma diagnosis and control medication, and it 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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