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Insurance status as a risk factor for foreign body ingestion or aspiration
E M Arjmand1, H R Muntz, S L Stratmann
1Department of Surgery (Otolaryngology) and Pediatrics, Southern Illinois University School of Medicine, Springfield 62794-1618, USA.
Insights
Lack of private health insurance increases children's risk for foreign body ingestion and aspiration. Preschoolers are more vulnerable, highlighting the need for education and preventive care.
Area of Science:
- Pediatric Medicine
- Public Health
- Emergency Medicine
Background:
- Foreign body ingestion and aspiration are significant pediatric emergencies.
- Socioeconomic factors, including health insurance status, may influence risk.
Purpose of the Study:
- To investigate the association between lack of private health insurance and the risk of foreign body ingestion or aspiration in children.
Main Methods:
- Retrospective review of 125 pediatric patients with esophageal or airway foreign bodies at a tertiary care center.
- Analysis of patient demographics and insurance status.
Main Results:
- Fifty-six percent of preschool patients and 20% of school-age patients with foreign bodies were uninsured.
- Preschool children comprised the majority of patients with airway (85%) and esophageal (84%) foreign bodies.
- Uninsured preschool children were more likely to have food aspirations (46%) and aspirations of non-food items (50%).
Conclusions:
- Insurance status is a significant risk factor for pediatric foreign body ingestion and aspiration.
- Preschool-aged children are disproportionately affected and more likely to be uninsured.
- Anticipatory guidance and public education are crucial for preventive care to reduce incidence.
Objective:
To determine whether the lack of private health insurance places children at increased risk for foreign body ingestion or aspiration.
Design:
Retrospective review.
Setting:
St. Louis Children's Hospital, a tertiary care center.
Patients:
Consecutive sample of 125 patients with esophageal or airway foreign bodies.
Results:
Fifty percent of all patients had private health insurance. Fifty-six percent of all preschool patients and 20% of all school-age patients were uninsured (P < 0.01, Fisher's exact test). Eighty-five percent of patients with airway foreign bodies, and 84% of patients with esophageal foreign bodies were in the preschool group. Sixty-one percent of preschool patients and 21% of school-age patients with esophageal foreign bodies were uninsured (P < 0.05). Forty-six percent of preschool patients with food aspiration lacked health insurance (88% of these children were fed the aspirated item). No school-age group was available for comparison. Fifty percent of preschool children with aspiration of non food items were uninsured, as were 16% of their school-age counterparts.
Conclusions:
Insurance status must be considered as a risk factor for foreign body aspiration and ingestion. Preschool children are more likely to lack private health insurance than school-age children with the same diagnosis. In a majority of aspiration events, the child was being fed the inappropriate food item, perhaps indicating a lack of caretaker education and anticipatory guidance. A direct focus on 'passive protection', anticipatory guidance in clinics for all patients, and public education with emphasis on preventive care are proposed as means to decrease the incidence of airway and esophageal foreign bodies in children.