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The relationship between insurance class and severity of presentation of inflammatory bowel disease in children
W Spivak1, R Sockolow, A Rigas
1Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA.
Insights
Underinsured children with inflammatory bowel disease (IBD) present with more severe symptoms and poorer health indicators. This suggests insurance status impacts IBD severity and access to timely, quality healthcare for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Health Services Research
- Clinical Medicine
Background:
- Inflammatory bowel disease (IBD) affects children, with presentation severity potentially influenced by socioeconomic factors.
- Insurance status is a key determinant of healthcare access and quality.
Purpose of the Study:
- To investigate the association between insurance class and the severity of inflammatory bowel disease (IBD) presentation in pediatric patients.
- To compare clinical and laboratory parameters between underinsured and privately insured children with IBD.
Main Methods:
- A case-control study matched 20 underinsured children (no insurance or Medicaid) with 20 privately insured children by diagnosis and age.
- Patient-reported data and eight laboratory values were compared between the two groups.
- The study included patients with Crohn's disease and ulcerative colitis.
Main Results:
- Underinsured children experienced over 2.5 times more weight loss and a significantly longer delay in diagnosis compared to privately insured children.
- Laboratory findings indicated greater illness severity in underinsured patients, including lower hemoglobin, higher erythrocyte sedimentation rate, and elevated platelet counts.
- Significantly depressed alkaline phosphatase levels were observed in the underinsured group.
Conclusions:
- Underinsured children with IBD exhibit more severe disease at presentation, evidenced by clinical and laboratory markers.
- Inferior access to quality healthcare for underinsured patients is postulated as a contributing factor to disease severity.
- Insurance status is a critical factor influencing pediatric IBD outcomes.
Objective:
To determine whether there is an association between insurance class and the severity of presentation of inflammatory bowel disease in children.
Methods:
Twenty underinsured (either no insurance or Medicaid) children were computer-matched with 20 children with private insurance with regard to diagnosis and age but without regard to severity of disease from a pool of 63 patients (20 underinsured patients and 43 insured patients). We compared four patient-reported parameters and eight laboratory values.
Results:
There were 22 patients with Crohn's disease (11 underinsured and 11 insured) and 18 patients with ulcerative colitis (nine underinsured and nine insured), with a mean age at diagnosis of 13.7 +/- 4.2 yr in the underinsured and 13.4 +/- 3.8 yr in the privately insured patients. Patients in the underinsured category had more than 2.5 times the weight loss of the privately insured patients (20.0 +/- 13.9 vs. 7.8 +/- 8.6, p < 0.005) and longer delay in months (10.3 +/- 10.9 vs. 2.7 +/- 2.6, p < 0.005) before the diagnosis was made. Laboratory data in the underinsured children indicated that they were more ill at time of presentation than the insured patients. The underinsured patients had significantly lower hemoglobins (10.5 +/- 2.4 vs. 12.5 +/- 2.1, p < 0.01), a higher erythrocyte sedimentation rate (59 +/- 35 vs. 21 +/- 24, p < 0.005), and higher platelet counts (536 +/- 205 x 10(3) vs. 418 +/- 140 x 10(3), p < 0.05) compared to the insured group. Alkaline phosphatase levels, normally elevated in children during osseous growth, were significantly depressed in the underinsured group when compared with the insured group (117 +/- 42 vs. 155 +/- 71, p = 0.05).
Conclusion:
Underinsured children have clinical and laboratory parameters that indicate that their disease is more severe at presentation than privately insured patients. We postulate that this is partly related to the fact that underinsured patients have inferior access to quality healthcare when compared to privately insured patients.