Association between insurance variability and early lung function in children with cystic fibrosis
Kimberly M Dickinson1, Kevin J Psoter2, Kristin A Riekert3
1Department of Pediatrics, Division of Pediatric Pulmonology, Johns Hopkins University, David M. Rubenstein Building, 200 North Wolfe Street, Baltimore, MD 21287, United States.
Insights
Health insurance variability in early childhood impacts lung function in cystic fibrosis (CF) patients. Children with intermittent or exclusively public insurance had lower lung function by age 6.
Area of Science:
- Pediatric Health
- Health Services Research
- Pulmonology
Background:
- Lower socioeconomic status (SES) is linked to worse outcomes in cystic fibrosis (CF).
- Previous research compared outcomes based on insurance type, but the impact of insurance status changes is unknown.
- Understanding insurance variability is crucial for addressing health disparities in pediatric CF.
Purpose of the Study:
- To analyze insurance status variations in early childhood for children with CF.
- To determine if insurance variability is associated with poorer health outcomes at age 6.
- To identify potential risks for lung function decline related to insurance changes.
Main Methods:
- Retrospective observational study using the Cystic Fibrosis Foundation Patient Registry (2000-2011 birth cohort).
- Insurance status categorized as always private, exclusively public, or intermittent private over the first 6 years.
- Outcomes assessed at age 6 included body mass index (BMI) and FEV1 percent predicted (maxFEV1pp).
Main Results:
- A significant portion of children (27.6%) experienced intermittent private insurance.
- No differences in BMI percentiles were observed across insurance groups.
- Children with intermittent private or exclusively public insurance showed lower maxFEV1pp (3.3% and 6.6% lower, respectively) at age 6 compared to always private insurance.
Conclusions:
- Many young children with CF have public or fluctuating private insurance.
- Insurance variability, not just public insurance, is linked to intermediate risks of lung function disparities by age 6.
- Addressing insurance instability may be key to improving early health outcomes in pediatric CF.
Background:
Lower 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.
Objectives:
To describe the variability in insurance status in early childhood and to evaluate whether insurance variability was associated with poorer outcomes at age 6.
Methods:
Retrospective 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).
Results:
From 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.
Conclusions:
A 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.
Related Concept Videos
01:23Cystic Fibrosis: Pathogenesis
CF is primarily caused by a genetic mutation in a chromosome 7 gene coding for the cystic fibrosis transmembrane conductance regulator (CFTR) protein. The most common gene mutation leading to CF is the ΔF508 mutation,...
01:24Cystic Fibrosis: Management
Sinus disease and chronic...
01:19Factors Affecting Pulmonary Ventilation
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
01:20Chronic Obstructive Pulmonary Disease-I: Introduction
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:25Pulmonary Function Tests
Pulmonary Function Tests are crucial diagnostic tools for assessing respiratory function, particularly in patients with chronic respiratory disorders. They comprehensively evaluate lung volumes, ventilatory function, breathing mechanics, diffusion, and gas exchange. These tests help diagnose pulmonary diseases and play a significant role in monitoring disease progression, evaluating disability, and assessing response to therapy.
PFTs involve using a spirometer, a...