Background

Lower socioeconomic status (SES) has consistently been associated with poorer outcomes in individuals with cystic fibrosis (CF). Previous studies have compared outcomes for children with and without private insurance coverage, however the potential role of changes in insurance status on early health outcomes in children with CF remains unknown.

Objectives

To describe the variability in insurance status in early childhood and to evaluate whether insurance variability was associated with poorer outcomes at age 6.

Methods

Retrospective observational study using the Cystic Fibrosis Foundation Patient Registry. Insurance status was defined as: always private (including Tricare), exclusively public, or intermittent private insurance (private insurance and exclusively public insurance in separate years) during the first 6 years of life. Outcomes at age 6 included body mass index (BMI) and FEV₁ percent predicted (maxFEV₁pp).

Results

From a 2000–2011 birth cohort (n = 8,109), 42.3% always had private insurance, 30.0% had exclusively public insurance, and 27.6% had intermittent private insurance. BMI percentiles did not differ between groups; however, children with intermittent private insurance and exclusively public insurance had a 3.3% and 6.6% lower maxFEV₁pp at age 6, respectively, compared to those with always private insurance.

Conclusions

A substantial proportion of young children in a modern CF cohort have public or intermittent private insurance coverage. While public insurance has been associated with poorer health outcomes in CF, variability in health insurance coverage may also be associated with an intermediate risk of disparities in lung function as early as age 6.

中文翻译：

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保险可变性与囊性纤维化儿童早期肺功能的关联

背景

较低的社会经济地位 (SES) 一直与囊性纤维化 (CF) 患者的较差结果相关。以前的研究比较了有和没有私人保险的儿童的结果，但是保险状况的变化对 CF 儿童早期健康结果的潜在作用仍然未知。

目标

描述儿童早期保险状况的可变性，并评估保险可变性是否与 6 岁时较差的结果相关。

方法

使用 Cystic Fibrosis Foundation Patient Registry 的回顾性观察研究。保险状况被定义为：在生命的前 6 年内始终是私人保险（包括 Tricare）、完全是公共保险或间歇性私人保险（私人保险和完全公共保险在不同的年份）。6 岁时的结果包括体重指数 (BMI) 和 FEV ₁  % 预测值 (maxFEV ₁ pp)。

结果

从 2000 年至 2011 年的出生队列（n  = 8,109）中，42.3% 的人始终拥有私人保险，30.0% 的人拥有完全的公共保险，27.6% 的人拥有间歇性的私人保险。BMI 百分位数在各组之间没有差异；然而，与始终购买私人保险的儿童相比，购买间歇性私人保险和完全购买公共保险的儿童在 6 岁时的 maxFEV _{1 pp 分别降低 3.3% 和 6.6%。}

结论

现代 CF 人群中有相当一部分幼儿拥有公共或间歇性私人保险。虽然公共保险与 CF 较差的健康结果有关，但健康保险覆盖范围的可变性也可能与早在 6 岁时肺功能差异的中间风险有关。