PDF(Pubmed)
Abstract：
UNASSIGNED: Although children with asthma are often successfully treated by primary care clinicians, outpatient specialist care is recommended for those with poorly controlled disease. Little is known about differences in specialist use for asthma among children with Medicaid vs private insurance.
UNASSIGNED: To examine differences among children with asthma regarding receipt of asthma specialist care by insurance type.
UNASSIGNED: In this cross-sectional study using data from the Massachusetts All Payer Claims Database (APCD) between 2014 to 2020, children with asthma were identified and differences in receipt of outpatient specialist care by whether their insurance was public (Medicaid and the Children\'s Health Insurance Program) or private were examined. Eligible participants included children with asthma in 2015 to 2020 aged 2 to 17 years. Data analysis was conducted from January 2023 to April 2024.
UNASSIGNED: Medicaid vs private insurance.
UNASSIGNED: The primary outcome was receipt of specialist care (any outpatient visit with a pulmonology, allergy and immunology, or otolaryngology physician). Multivariable logistic regression models estimated differences in receipt of specialist care by insurance type accounting for child and area characteristics including demographics, health status, persistent asthma, calendar year, and zip code characteristics. Additional analyses examined if the associations of specialist care with insurance type varied by asthma persistence and severity, and whether associations varied over time.
UNASSIGNED: Among 198 101 unique children, there were 432 455 child-year observations (186 296 female [43.1%] and 246 159 male [56.9%]; 211 269 aged 5 to 11 years [48.9%]; 82 108 [19.0%] with persistent asthma) including 286 408 (66.2%) that were Medicaid insured and 146 047 (33.8%) that were privately insured. Although persistent asthma was more common among child-year observations with Medicaid vs private insurance (57 381 [20.0%] vs 24 727 [16.9%]), children with Medicaid were less likely to receive specialist care. Overall, 64 239 child-year observations (14.9%) received specialist care, with substantially lower rates for children with Medicaid vs private insurance (34 093 child-year observations [11.9%] vs 30 146 child-year observations [20.6%]). Regression-based estimates confirmed these disparities; children with Medicaid had 55% lower odds of receiving specialist care (adjusted odds ratio, 0.45; 95% CI, 0.43 to 0.47) and a regression-adjusted 9.7 percentage point (95% CI, -10.4 percentage points to -9.1 percentage points) lower rate of receipt of specialist care. Compared with children with private insurance, there was an additional 3.2 percentage point (95% CI, 2.0 percentage points to 4.4 percentage points) deficit for children with Medicaid with persistent asthma.
UNASSIGNED: In this cross-sectional study, children with Medicaid were less likely to receive specialist care, with the largest gaps among those with persistent asthma. These findings suggest that closing this care gap may be one approach to addressing ongoing disparities in asthma outcomes.
UNASSIGNED: To examine differences among children with asthma regarding receipt of asthma specialist care by insurance type.
UNASSIGNED: In this cross-sectional study using data from the Massachusetts All Payer Claims Database (APCD) between 2014 to 2020, children with asthma were identified and differences in receipt of outpatient specialist care by whether their insurance was public (Medicaid and the Children\'s Health Insurance Program) or private were examined. Eligible participants included children with asthma in 2015 to 2020 aged 2 to 17 years. Data analysis was conducted from January 2023 to April 2024.
UNASSIGNED: Medicaid vs private insurance.
UNASSIGNED: The primary outcome was receipt of specialist care (any outpatient visit with a pulmonology, allergy and immunology, or otolaryngology physician). Multivariable logistic regression models estimated differences in receipt of specialist care by insurance type accounting for child and area characteristics including demographics, health status, persistent asthma, calendar year, and zip code characteristics. Additional analyses examined if the associations of specialist care with insurance type varied by asthma persistence and severity, and whether associations varied over time.
UNASSIGNED: Among 198 101 unique children, there were 432 455 child-year observations (186 296 female [43.1%] and 246 159 male [56.9%]; 211 269 aged 5 to 11 years [48.9%]; 82 108 [19.0%] with persistent asthma) including 286 408 (66.2%) that were Medicaid insured and 146 047 (33.8%) that were privately insured. Although persistent asthma was more common among child-year observations with Medicaid vs private insurance (57 381 [20.0%] vs 24 727 [16.9%]), children with Medicaid were less likely to receive specialist care. Overall, 64 239 child-year observations (14.9%) received specialist care, with substantially lower rates for children with Medicaid vs private insurance (34 093 child-year observations [11.9%] vs 30 146 child-year observations [20.6%]). Regression-based estimates confirmed these disparities; children with Medicaid had 55% lower odds of receiving specialist care (adjusted odds ratio, 0.45; 95% CI, 0.43 to 0.47) and a regression-adjusted 9.7 percentage point (95% CI, -10.4 percentage points to -9.1 percentage points) lower rate of receipt of specialist care. Compared with children with private insurance, there was an additional 3.2 percentage point (95% CI, 2.0 percentage points to 4.4 percentage points) deficit for children with Medicaid with persistent asthma.
UNASSIGNED: In this cross-sectional study, children with Medicaid were less likely to receive specialist care, with the largest gaps among those with persistent asthma. These findings suggest that closing this care gap may be one approach to addressing ongoing disparities in asthma outcomes.
摘要：
尽管患有哮喘的儿童通常由初级保健临床医生成功治疗，对于疾病控制不佳的患者，建议进行门诊专科护理。关于医疗补助与私人保险儿童在哮喘方面的专家使用差异知之甚少。
■根据保险类型检查哮喘儿童在接受哮喘专科护理方面的差异。
■在这项横断面研究中，使用了2014年至2020年马萨诸塞州所有付款人索赔数据库（APCD）的数据，确定了哮喘儿童，并根据他们的保险是公共的（医疗补助和儿童健康保险计划）还是私人的，检查了接受门诊专科护理的差异。符合条件的参与者包括2015年至2020年2至17岁的哮喘儿童。数据分析于2023年1月至2024年4月进行。
■医疗补助与私人保险。
■主要结果是接受专科护理（任何肺科门诊就诊，过敏和免疫学，或耳鼻喉科医师)。多变量逻辑回归模型估计不同的保险类型，包括儿童和地区特征，包括人口统计学，健康状况,持续性哮喘,日历年,和邮政编码特征。其他分析检查了专科护理与保险类型的关联是否因哮喘的持久性和严重程度而有所不同，以及协会是否随着时间的推移而变化。
■在198101个独特的孩子中，有432455个儿童年观察(186296个女性[43.1%]和246159个男性[56.9%];211269个5~11岁[48.9%];82108个持续性哮喘患者[19.0%]),包括286408个医疗补助保险(66.2%)和146047个私人保险(33.8%).尽管持续性哮喘在医疗补助与私人保险的儿童年观察中更为常见（57381[20.0％]vs24727[16.9％]），接受医疗补助的儿童接受专科护理的可能性较小.总的来说,64239项儿童年观察(14.9%)接受专科护理，医疗补助儿童与私人保险的比率大大降低（34093个儿童年观察[11.9％]vs30146个儿童年观察[20.6％]）。基于回归的估计证实了这些差异；医疗补助的儿童接受专科护理的几率降低了55%(调整后的优势比，0.45；95%CI，0.43至0.47）和回归调整后的9.7个百分点（95%CI，-10.4个百分点至-9.1个百分点）的专科护理接收率降低。与有私人保险的儿童相比，有持续性哮喘的Medicaid患儿还有3.2个百分点(95%CI,2.0~4.4个百分点)的不足.
■在这项横断面研究中，接受医疗补助的儿童不太可能接受专科护理，在持续性哮喘患者中差距最大。这些发现表明，缩小这一护理差距可能是解决哮喘结局持续差异的一种方法。
■根据保险类型检查哮喘儿童在接受哮喘专科护理方面的差异。
■在这项横断面研究中，使用了2014年至2020年马萨诸塞州所有付款人索赔数据库（APCD）的数据，确定了哮喘儿童，并根据他们的保险是公共的（医疗补助和儿童健康保险计划）还是私人的，检查了接受门诊专科护理的差异。符合条件的参与者包括2015年至2020年2至17岁的哮喘儿童。数据分析于2023年1月至2024年4月进行。
■医疗补助与私人保险。
■主要结果是接受专科护理（任何肺科门诊就诊，过敏和免疫学，或耳鼻喉科医师)。多变量逻辑回归模型估计不同的保险类型，包括儿童和地区特征，包括人口统计学，健康状况,持续性哮喘,日历年,和邮政编码特征。其他分析检查了专科护理与保险类型的关联是否因哮喘的持久性和严重程度而有所不同，以及协会是否随着时间的推移而变化。
■在198101个独特的孩子中，有432455个儿童年观察(186296个女性[43.1%]和246159个男性[56.9%];211269个5~11岁[48.9%];82108个持续性哮喘患者[19.0%]),包括286408个医疗补助保险(66.2%)和146047个私人保险(33.8%).尽管持续性哮喘在医疗补助与私人保险的儿童年观察中更为常见（57381[20.0％]vs24727[16.9％]），接受医疗补助的儿童接受专科护理的可能性较小.总的来说,64239项儿童年观察(14.9%)接受专科护理，医疗补助儿童与私人保险的比率大大降低（34093个儿童年观察[11.9％]vs30146个儿童年观察[20.6％]）。基于回归的估计证实了这些差异；医疗补助的儿童接受专科护理的几率降低了55%(调整后的优势比，0.45；95%CI，0.43至0.47）和回归调整后的9.7个百分点（95%CI，-10.4个百分点至-9.1个百分点）的专科护理接收率降低。与有私人保险的儿童相比，有持续性哮喘的Medicaid患儿还有3.2个百分点(95%CI,2.0~4.4个百分点)的不足.
■在这项横断面研究中，接受医疗补助的儿童不太可能接受专科护理，在持续性哮喘患者中差距最大。这些发现表明，缩小这一护理差距可能是解决哮喘结局持续差异的一种方法。
