title: The association of health insurance and disease impairment with reported asthma prevalence in U.S. children.
abstract: OBJECTIVE
  To test the hypotheses that reported asthma prevalence is higher among insured than uninsured children and that insurance-based differences in asthma diagnosis, treatment, and health care utilization are associated with disease severity.
  
  
  METHODS
  National Health and Nutrition Examination Survey, 2003-2008.
  
  
  METHODS
  We used multivariate logistic regression to examine the relationship between insurance and asthma symptom severity with asthma diagnosis, treatment, and acute care utilization.
  
  
  RESULTS
  In multivariate analysis, insured children had greater odds of reporting a current diagnosis of asthma than uninsured children (odds ratio [OR] = 2.08, 95% confidence interval [CI]: 1.47-2.94). When interactions between insurance and asthma impairment were included, insurance was associated with greater odds of diagnosis among children with intermittent (OR = 4.08, 95% CI: 1.57-10.61), but not persistent, symptoms. Among children with intermittent symptoms, insurance was associated with inhaled corticosteroid use (OR = 4.51, 95% CI: 1.18-17.24) and asthma-related acute care utilization (OR = 5.21, 95% CI: 1.21-23.53); these associations were nonsignificant among children with persistent symptoms.
  
  
  CONCLUSIONS
  Being insured increases only the likelihood that a child with intermittent, not persistent, asthma symptoms will receive an asthma diagnosis and control medication, and it may not reduce acute care utilization. Although universal insurance may increase detection and management of undiagnosed childhood asthma, theorized cost savings from reduced acute care utilization might not materialize.
authors.affiliation: David Geffen School of Medicine at UCLA, UCLA/RAND Center for Adolescent Health Promotion, 10960 Wilshire Blvd., Los Angeles, CA 90024, USA. tcoker@mednet.ucla.edu
authors.forename: Tumaini R
authors.initials: TR
authors.lastname: Coker
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kaplan
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents
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