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

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.