Association between insurance variability and early lung function in children with cystic fibrosis |
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| Affiliation: | 1. Department of Pediatrics, Division of Pediatric Pulmonology, Johns Hopkins University, David M. Rubenstein Building, 200 North Wolfe Street, Baltimore, MD 21287, United States;2. Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University, Baltimore, MD, United States;3. Department of Medicine, Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States;1. Consultant in Paediatric Respiratory Medicine, Noah''s Ark Children''s Hospital for Wales, Cardiff, UK;2. Consultant in Paediatric Respiratory Medicine, Cardiff University School of Medicine, Cardiff, UK;1. National Heart & Lung Institute, Imperial College London, UK;2. Royal Brompton and Harefield Hospitals, London, UK;3. Department of Infectious Diseases, Imperial College London, UK;4. Department of Medicine, Queen''s University Belfast, UK;1. Department of Health Services, University of Washington, Seattle, Washington, United States;2. School of Pharmacy, University of Washington, Seattle, Washington, United States;3. Department of Radiology, University of Washington, Seattle, Washington, United States;4. Department of Medicine, University of Washington, Seattle, Washington, United States;5. Department of Pediatrics, University of Washington, Seattle, Washington, United States;6. Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States;1. School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, Co. Londonderry, Northern Ireland, BT52 1SA, UK,;2. Northern Ireland Regional Adult Cystic Fibrosis Centre, Level 8, Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland, BT9 7AB, UK,;3. Laboratory for Disinfection and Pathogen Elimination Studies, Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland, BT9 7AD, UK.;1. Department of Radiology, Cincinnati Children’s Hospital and Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, OH, USA;2. Division of Biostatistics and Bioinformatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA;3. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH, USA;4. Department of Radiology, Nationwide Children’s Hospital and the College of Medicine, Ohio State University, Columbus, OH, USA;5. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH, USA;1. Cystic Fibrosis Therapeutics Development Network Coordinating Center, Seattle Children''s Research Institute;2. Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA;3. Department of Biostatistics, University of Washington, Seattle, WA, USA;4. University of Washington School of Medicine, Seattle, WA, USA;5. Johns Hopkins University School of Medicine, Baltimore, MD, USA |
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| Abstract: | BackgroundLower socioeconomic status (SES) has consistently been associated with poorer outcomes in individuals with cystic fibrosis (CF). Previous studies have compared outcomes for children with and without private insurance coverage, however the potential role of changes in insurance status on early health outcomes in children with CF remains unknown.ObjectivesTo describe the variability in insurance status in early childhood and to evaluate whether insurance variability was associated with poorer outcomes at age 6.MethodsRetrospective observational study using the Cystic Fibrosis Foundation Patient Registry. Insurance status was defined as: always private (including Tricare), exclusively public, or intermittent private insurance (private insurance and exclusively public insurance in separate years) during the first 6 years of life. Outcomes at age 6 included body mass index (BMI) and FEV1 percent predicted (maxFEV1pp).ResultsFrom a 2000–2011 birth cohort (n = 8,109), 42.3% always had private insurance, 30.0% had exclusively public insurance, and 27.6% had intermittent private insurance. BMI percentiles did not differ between groups; however, children with intermittent private insurance and exclusively public insurance had a 3.3% and 6.6% lower maxFEV1pp at age 6, respectively, compared to those with always private insurance.ConclusionsA substantial proportion of young children in a modern CF cohort have public or intermittent private insurance coverage. While public insurance has been associated with poorer health outcomes in CF, variability in health insurance coverage may also be associated with an intermediate risk of disparities in lung function as early as age 6. |
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