Factors Associated With Cost Barriers to Asthma Management by Insurance Coverage Status Among US Adults

Asthma is a common chronic condition in the United States, yet despite insurance coverage, patients with asthma can potentially face cost barriers and limit access to care.

To investigate the predictors of cost barriers in asthma care and explore variations based on insurance coverage status.

We used 2019 to 2021 Behavioral Risk Factor Surveillance System Survey data and multivariable logistic regression to evaluate the relationship between insurance coverage (full year vs partial or no coverage) as study exposure and self-reported cost barriers (to primary care, asthma specialists, and asthma medications) as study outcomes.

Among 25,996 patients, 86.3% had full-year insurance coverage whereas 13.7% had partial or no insurance coverage. Almost half of patients with partial or no coverage reported cost barriers (28.4% to primary care, 13.9% to asthma specialists, and 33% to asthma medications) compared with 10.6% fully insured individuals (3.3% to primary care, 2.7% to asthma specialists, and 8.3% to asthma medications; P < .001). Non-Hispanic Black people with full-year insurance were more likely to face primary care cost barriers than were non-Hispanic White people (odds ratio = 1.91; 95% CI, 1.19-3.07). Males were less likely to have asthma medication cost barriers than were females regardless of insurance status. In addition, among fully insured participants, older age, higher income, and longer time since last asthma symptoms reduced any cost barriers, whereas recent emergency department visits or hospitalizations increased them (odds ratio = 2.23; 95% CI, 1.74-2.86). In partially or uninsured participants, higher income and time since symptoms were protective, but emergency department visits or hospitalizations also increased cost barriers.

Although partially or uninsured individuals face greater cost challenges, fully insured individuals also experience significant barriers, particularly among specific subgroups such as non-Hispanic Black people. Targeted interventions are crucial to addressing these disparities and improving access to affordable asthma care for all.