Lack of health insurance coverage and asthma management behavior

In 2008, over 41 million American adults were estimated to have been diagnosed with asthma sometime in their lives; 26.7 million currently have it. Asthma accounted for more than $19.7 billion in annual expenditures for health and lost productivity in 2007. Inadequate or lack of health insurance impacts access to appropriate healthcare and affects asthmatics' management behaviors for their chronic condition. Data from the 2008 North Carolina Behavioral Risk Factor Surveillance System were used for bivariate and multiple logistic regression analyses for the modeling of asthma management behaviors. Adults (18-64 years) with current asthma and without insurance were the index cases (n=901) for comparison with those having either public or private insurance coverage. When compared to those without insurance, those with private or public insurance were significantly more likely to report the daily use of asthma medications [aOR=3.60 (CI=1.69-7.64); aOR=2.11 (CI=1.28-3.47]. The public insurance group was also significantly more likely to have an asthma attack [aOR=2.20 (CI=1.17-4.13)] than those with private or no insurance coverage. This group also reported higher inhaler usage [aOR=1.99 (CI=1.00-3.97)] than the other two groups. No significant differences were found between type of insurance and emergency department/urgent care visits, and doctor visit for urgent treatment of asthma. However, racial/ethnic and educational factors had a significant impact on these two asthma management outcomes. These results show that asthmatics without insurance were less likely to have access to asthma medication, which raise issues regarding inadequate disease management and increased disease exacerbation and their subsequent impacts on healthcare utilization.