Health insurance and use of recommended routine care in adults with cystic fibrosis

Susan S. Li, Don Hayes, Joseph D. Tobias, Wayne J Morgan, Dmitry Tumin

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Low socioeconomic status is correlated with worse outcomes in patients with cystic fibrosis (CF). Whether insurance status impacts adherence to care in this population is unknown. Methods: Patients ≥18 years old in the CF Foundation Patient Registry (2005-2013) were grouped based on reported annual insurance as private, public (Medicaid, Medicare or state medical assistance program), others or no insurance. Random effects logistic regression evaluated association between change in insurance status and annual use of recommended routine care. Results: A total of 18 358 patients contributed 94 690 years of data to the analysis. In descriptive analysis, adherence to recommended routine care (≥4 clinic visits, ≥4 respiratory cultures and ≥2 pulmonary function tests per year) and recommended chronic medications for those with moderate to severe lung disease (dornase alfa and inhaled tobramycin or aztreonam if Pseudomoas aeruginosa in respiratory cultures) was most common in public insurance compared to other insurance types. In multivariable logistic regression, public insurance was associated with greater use of recommended care relative to private insurance (OR = 1.16; 95% confidence interval: 1.10-1.22; P < .001), while being uninsured was associated with lower odds of using recommended care (OR = 0.37; 95% confidence interval: 0.31-0.46; P < .001). Conclusions: For adults with CF in the United States, public insurance was associated with greater use of routine care than private coverage. Being uninsured was strongly associated with not using routine care. Further efforts to improve access to CF care should address the feasibility of universal and continuous insurance coverage in the CF population.

Original languageEnglish (US)
JournalClinical Respiratory Journal
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Health Insurance
Insurance
Cystic Fibrosis
Insurance Coverage
Logistic Models
Confidence Intervals
Medical Assistance
Aztreonam
Tobramycin
Respiratory Function Tests
Medicaid
Ambulatory Care
Medicare
Social Class
Population
Lung Diseases
Registries

Keywords

  • Access to care
  • Health care disparities
  • Health insurance
  • Medicaid
  • Medicare

ASJC Scopus subject areas

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine
  • Genetics(clinical)

Cite this

Health insurance and use of recommended routine care in adults with cystic fibrosis. / Li, Susan S.; Hayes, Don; Tobias, Joseph D.; Morgan, Wayne J; Tumin, Dmitry.

In: Clinical Respiratory Journal, 01.01.2018.

Research output: Contribution to journalArticle

@article{493d433425f44fef8bb04899b8598316,
title = "Health insurance and use of recommended routine care in adults with cystic fibrosis",
abstract = "Background: Low socioeconomic status is correlated with worse outcomes in patients with cystic fibrosis (CF). Whether insurance status impacts adherence to care in this population is unknown. Methods: Patients ≥18 years old in the CF Foundation Patient Registry (2005-2013) were grouped based on reported annual insurance as private, public (Medicaid, Medicare or state medical assistance program), others or no insurance. Random effects logistic regression evaluated association between change in insurance status and annual use of recommended routine care. Results: A total of 18 358 patients contributed 94 690 years of data to the analysis. In descriptive analysis, adherence to recommended routine care (≥4 clinic visits, ≥4 respiratory cultures and ≥2 pulmonary function tests per year) and recommended chronic medications for those with moderate to severe lung disease (dornase alfa and inhaled tobramycin or aztreonam if Pseudomoas aeruginosa in respiratory cultures) was most common in public insurance compared to other insurance types. In multivariable logistic regression, public insurance was associated with greater use of recommended care relative to private insurance (OR = 1.16; 95{\%} confidence interval: 1.10-1.22; P < .001), while being uninsured was associated with lower odds of using recommended care (OR = 0.37; 95{\%} confidence interval: 0.31-0.46; P < .001). Conclusions: For adults with CF in the United States, public insurance was associated with greater use of routine care than private coverage. Being uninsured was strongly associated with not using routine care. Further efforts to improve access to CF care should address the feasibility of universal and continuous insurance coverage in the CF population.",
keywords = "Access to care, Health care disparities, Health insurance, Medicaid, Medicare",
author = "Li, {Susan S.} and Don Hayes and Tobias, {Joseph D.} and Morgan, {Wayne J} and Dmitry Tumin",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/crj.12767",
language = "English (US)",
journal = "Clinical Respiratory Journal",
issn = "1752-6981",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Health insurance and use of recommended routine care in adults with cystic fibrosis

AU - Li, Susan S.

AU - Hayes, Don

AU - Tobias, Joseph D.

AU - Morgan, Wayne J

AU - Tumin, Dmitry

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Low socioeconomic status is correlated with worse outcomes in patients with cystic fibrosis (CF). Whether insurance status impacts adherence to care in this population is unknown. Methods: Patients ≥18 years old in the CF Foundation Patient Registry (2005-2013) were grouped based on reported annual insurance as private, public (Medicaid, Medicare or state medical assistance program), others or no insurance. Random effects logistic regression evaluated association between change in insurance status and annual use of recommended routine care. Results: A total of 18 358 patients contributed 94 690 years of data to the analysis. In descriptive analysis, adherence to recommended routine care (≥4 clinic visits, ≥4 respiratory cultures and ≥2 pulmonary function tests per year) and recommended chronic medications for those with moderate to severe lung disease (dornase alfa and inhaled tobramycin or aztreonam if Pseudomoas aeruginosa in respiratory cultures) was most common in public insurance compared to other insurance types. In multivariable logistic regression, public insurance was associated with greater use of recommended care relative to private insurance (OR = 1.16; 95% confidence interval: 1.10-1.22; P < .001), while being uninsured was associated with lower odds of using recommended care (OR = 0.37; 95% confidence interval: 0.31-0.46; P < .001). Conclusions: For adults with CF in the United States, public insurance was associated with greater use of routine care than private coverage. Being uninsured was strongly associated with not using routine care. Further efforts to improve access to CF care should address the feasibility of universal and continuous insurance coverage in the CF population.

AB - Background: Low socioeconomic status is correlated with worse outcomes in patients with cystic fibrosis (CF). Whether insurance status impacts adherence to care in this population is unknown. Methods: Patients ≥18 years old in the CF Foundation Patient Registry (2005-2013) were grouped based on reported annual insurance as private, public (Medicaid, Medicare or state medical assistance program), others or no insurance. Random effects logistic regression evaluated association between change in insurance status and annual use of recommended routine care. Results: A total of 18 358 patients contributed 94 690 years of data to the analysis. In descriptive analysis, adherence to recommended routine care (≥4 clinic visits, ≥4 respiratory cultures and ≥2 pulmonary function tests per year) and recommended chronic medications for those with moderate to severe lung disease (dornase alfa and inhaled tobramycin or aztreonam if Pseudomoas aeruginosa in respiratory cultures) was most common in public insurance compared to other insurance types. In multivariable logistic regression, public insurance was associated with greater use of recommended care relative to private insurance (OR = 1.16; 95% confidence interval: 1.10-1.22; P < .001), while being uninsured was associated with lower odds of using recommended care (OR = 0.37; 95% confidence interval: 0.31-0.46; P < .001). Conclusions: For adults with CF in the United States, public insurance was associated with greater use of routine care than private coverage. Being uninsured was strongly associated with not using routine care. Further efforts to improve access to CF care should address the feasibility of universal and continuous insurance coverage in the CF population.

KW - Access to care

KW - Health care disparities

KW - Health insurance

KW - Medicaid

KW - Medicare

UR - http://www.scopus.com/inward/record.url?scp=85041701777&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041701777&partnerID=8YFLogxK

U2 - 10.1111/crj.12767

DO - 10.1111/crj.12767

M3 - Article

C2 - 29356436

AN - SCOPUS:85041701777

JO - Clinical Respiratory Journal

JF - Clinical Respiratory Journal

SN - 1752-6981

ER -