Background

Asthma disproportionately affects individuals with lower income. High uninsured rates are a potential driver for this disparity. Previous studies have not examined the effect of the Affordable Care Act (ACA) on asthma-related outcomes for individuals with low income.

Research Question

What is the impact of insurance status and the ACA on asthma outcomes for adults 18 to 64 years of age in households with low-income status?

Study Design and Methods

This study was a pooled cross-sectional observational study using National Health Interview Survey data from 2011 through 2013 and 2016 through 2018. Individuals 18 to 64 years of age with a history of asthma and low income were included. Survey-weighted regression modeling and mediation analysis was used to explore the relationship of insurance status and asthma control. Univariate and multivariate survey-weighted regression modeling then was used to evaluate the correlation of the ACA and asthma outcomes.

Results

We identified 4,043 individual observations. Having health insurance was correlated with improved asthma outcomes (OR, 1.25). This relationship was completely mediated by cost barriers to medications and physician visits. Although the ACA resulted in significant changes in insurance status (OR, 2.4), no statistically significant change was found in asthma outcomes. Furthermore, cost barriers to both medications and physician visits persisted in the insured population, 20.7% and 30.0%, respectively.

Interpretation

Insurance coverage is associated with improved asthma control for adults 18 to 64 years from households with low socioeconomic status. The ACA reduced the rates of uninsured, but did not have the same magnitude of effect on reducing cost barriers. The persistence of cost barriers may explain in part the lack of population-level improvement in asthma control.

中文翻译：

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美国低收入成年人的保险状况与平价医疗法案之间的关系

背景

哮喘对低收入人群的影响尤为严重。高未保险率是造成这种差异的潜在驱动因素。以前的研究没有检查平价医疗法案 (ACA) 对低收入人群哮喘相关结局的影响。

研究问题

保险状况和 ACA 对低收入家庭中 18 至 64 岁成年人的哮喘结果有何影响？

研究设计和方法

这项研究是一项汇总的横断面观察性研究，使用了 2011 年至 2013 年以及 2016 年至 2018 年的全国健康访谈调查数据。包括有哮喘病史和低收入的 18 至 64 岁的个人。使用调查加权回归模型和中介分析来探讨保险状况与哮喘控制的关系。然后使用单变量和多变量调查加权回归模型来评估 ACA 和哮喘结果的相关性。

结果

我们确定了 4,043 个单独的观察结果。拥有健康保险与改善哮喘预后相关（OR，1.25）。这种关系完全由药物和医生就诊的成本障碍所调节。尽管 ACA 导致保险状况发生显着变化（OR，2.4），但未发现哮喘结局发生统计学上的显着变化。此外，在参保人群中，药物和就诊的成本障碍仍然存在，分别为 20.7% 和 30.0%。

解释

保险范围与改善社会经济地位低下家庭 18 至 64 岁成年人的哮喘控制有关。ACA 降低了未投保者的比率，但对降低成本壁垒没有同样大的影响。成本障碍的持续存在可能部分解释了哮喘控制在人口水平上缺乏改善。