The 130th Annual Meeting of APHA

Abstract #47196

Whitney P. Witt, PhD, MPH¹, William H. Crown, PhD², Jonathan Maguire, BA², Ernst R. Berndt, PhD³, and Stan N. Finkelstein, MD³. (1) Massachusetts General Hospital for Children, Center for Child and Adolescent Health Policy, Harvard University, School of Medicine, 50 Staniford Street, Suite 901, Boston, MA 02114, (617) 724-2845, wwitt@partners.org, (2) Outcomes Research & Econometrics, The MEDSTAT Group, Inc., 125 CambridgePark Drive, Cambridge, MA 02140, (3) Sloan School of Management, MIT, MIT, E52-452, 50 Memorial Drive, Cambridge, MA 02142-1347

Chronic illness and disability are potential stressors that may present a substantial additional risk for family dysfunction, and subsequent increased use of medical services and healthcare expenditures. This particular study focuses on the presence of asthma in the family, the mental health status of family members, and the impact of asthma on families’ healthcare use and expenditures. We hypothesize that having an asthmatic family member will be associated with higher than expected health care use and expenditures for both the family unit and non-asthmatic family members. The hypothesized mechanism for increased service use is the stress associated with taking care of a chronically ill family member. The data sources for this study are administrative medical claims and enrollment data from a large employer database managed by the MEDSTAT Group, and cover over 90,000 asthmatic episodes for employees and their dependents, nationwide. Data encompass the 1995-99 time period, for families receiving care in either a fee for service or HMO managed care context. Families with an asthmatic(s) will be identified through claims and will be compared with families with healthy members. Race, ethnicity, and income information will be extracted from the Bureau of Health Professions Area Resource File (ARF), a compendium of county-level information produced annually, and merged with the MEDSTAT analytic file by county. The sample consists of nearly 200,000 families, with 35% of all families with an asthmatic member. As compared to families without asthmatics, families with asthmatic members were more likely to be: older, living alone or with one other family member, and enrolled in an HMO managed care plan (versus fee-for-service) (All p-values <0.05). Final results will include a report of the presence of psychological morbidity in the family, mean utilization rates these families, and mean expenditures for families with and without an asthmatic member. Regression analyses will examine the role of having an asthmatic family member on the use and expenditures of the family unit and members without asthma. All analyses will be stratified by age. If the hypotheses are supported, these findings will underscore the importance of addressing caregivers’ health and mental healthcare needs in ensuring timely, appropriate and effective care for asthmatics and their family members.

Learning Objectives: At the conclusion of the session the participant in this session will be able to

• Articulate (on a family-level) the inter-relationships between chronic illness, psychological morbidity, and use of healthcare and expenditures.
• Describe the presence of psychological morbidity among families with and without asthmatic members. 3.) Assess if asthma in the family is associated with higher than expected health care use and expenditures for both the family unit and non-asthmatic family members.

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Work part-time for The MEDSTAT Group, Inc. which manages the Marketscan database (which were used in this study)