title: Relationship of asthma management, socioeconomic status, and medication insurance characteristics to exacerbation frequency in children with asthma.
abstract: BACKGROUND
  less than 25% of asthmatic children are well controlled.
  
  
  OBJECTIVE
  to identify factors associated with asthma exacerbation causing emergency department (ED) visits or hospitalizations related to health status, socioeconomic status (SES), and drug insurance.
  
  
  METHODS
  in this retrospective cohort study, complete data were collected on 490 asthmatic children regarding demographics, SES, drug plan characteristics, health status, health resource use, and symptoms. Interview data were linked to administrative data on asthma ED visits and hospitalizations occurring in the following year. Multiple Poisson regression identified independent variables associated with ED visits or hospitalizations in the full cohort and in a subgroup with prescription drug insurance.
  
  
  RESULTS
  younger age, previous emergency visits, nebulizer use, pet ownership, and receipt of asthma education but not an action plan were significantly associated with more frequent exacerbations. In the full cohort, children with high income adequacy had 28% fewer exacerbations than did children with low income adequacy. In the subgroup with drug insurance, girls had 26% fewer exacerbations than did boys, and children with food, drug, or insect allergies had 52% more exacerbations than did children without allergies. Children of families with annual insurance deductibles greater than $90 had 95% fewer exacerbations. Every percentage increase in the proportion of income spent out-of-pocket on asthma medications was associated with a 14% increase in exacerbations.
  
  
  CONCLUSIONS
  asthma history, disease management factors, and SES were associated with exacerbations requiring urgent care. In families with drug plans, the magnitude of asthma medication cost-sharing as a proportion of household income, rather than income alone, was significantly associated with exacerbations.
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Ungar
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.forename: Peter
authors.initials: P
authors.lastname: Bikangaga
authors.forename: Milton
authors.initials: M
authors.lastname: Gold
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.forename: Anita L
authors.initials: AL
authors.lastname: Kozyrskyj
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017047:Cost Sharing; D005260:Female; D006801:Humans; D007223:Infant; D007356:Insurance, Pharmaceutical Services; D008297:Male; D012189:Retrospective Studies; D012923:Social Class