title: Differences in health care access and utilization between adolescents and young adults with asthma.
abstract: OBJECTIVE
  Studies suggest that young adults have worse health care access, use less primary care, and visit emergency departments more frequently than adolescents. We examined whether these differences existed between older adolescents and young adults with asthma.
  
  
  METHODS
  Using nationally representative data from the 1999 to 2009 Medical Expenditure Panel Survey, we performed cross-sectional comparisons of access and utilization between older adolescents (ages 14-17) and young adults (ages 19-25) with asthma. In longitudinal analyses, we assessed whether changes in health insurance coverage, schooling, and adult presence at home predicted changes in access and utilization.
  
  
  RESULTS
  Young adults with asthma were less likely to have a usual source of care (-13.7 percentage points; P < .001) or primary care visit within the past year (-13.9 percentage points; P = .006). They were less likely to fill a short-acting beta-agonist prescription (-10.6 percentage points; P = .02) and more likely to visit the emergency department within the past year (+9.7 percentage points; P = .01). Adjusting for differences in insurance coverage reduced differences in usual source of care and primary care use by 32.4% to 38.0% but reduced the difference in emergency department use by only 10.3%. Among participants aged 16 to 19 in the first survey year, becoming uninsured strongly predicted losing a usual source of care (change relative to no coverage loss: -25.2 percentage points; P = .003).
  
  
  CONCLUSIONS
  Compared with older adolescents with asthma, young adults with asthma have worse health care access and may use care less optimally. These differences were associated with but were not completely explained by differences in insurance coverage.
authors.affiliation: Harvard PhD Program in Health Policy, Harvard University, Cambridge, MA 02138, USA. kao-ping.chua@childrens.harvard.edu
authors.forename: Kao-Ping
authors.initials: KP
authors.lastname: Chua
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
authors.forename: J Michael
authors.initials: JM
authors.lastname: McWilliams
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D020380:Needs Assessment; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
keywords: adolescents; asthma; health care utilization; health insurance; young adult