Dr. Kaplan is now Director of the Office of Behavioral and Social Sciences Research (OBSSR) at NIH.
Bridging the Gap Between Research and Health Policy – Insights From Robert Wood Johnson Foundation Clinical Scholars
The Association of Health Insurance and Disease Impairment with Reported Asthma Prevalence in U.S. Children
Version of Record online: 27 OCT 2011
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 1pt2, pages 431–445, February 2012
How to Cite
Coker, T. R., Kaplan, R. M. and Chung, P. J. (2012), The Association of Health Insurance and Disease Impairment with Reported Asthma Prevalence in U.S. Children. Health Services Research, 47: 431–445. doi: 10.1111/j.1475-6773.2011.01339.x
- Issue online: 12 JAN 2012
- Version of Record online: 27 OCT 2011
- Centers for Disease Control. Grant Number: RC2HL101811-01
- National Heart, Lung, and Blood Institute, National Institutes of Health
- asthma impairment;
- health services utilization
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.
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 nonsignificant 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 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.