Stable private insurance linked to lower hospitalization rates in patients with asthma

Patients with asthma and stable public insurance or insurance instability, compared with stable private insurance, had increased odds of hospitalization, according to new data published in the Annals of the American Thoracic Society.

Researchers analyzed data from two academic medical centers and six community health care centers in Boston to identify 15,815 patients with asthma (mean age, 38.3 years; 65.9% women) and primary care visits from 2005 to 2013. Patient longitudinal care records were divided into 6-month intervals from January to June and July to December. The researchers identified insurance coverage categories during these intervals, which included stable private insurance, stable public insurance, insurance switches and always uninsured.

The patients included 6,099 non-Hispanic white adults, 1,049 Hispanic adults, 7,851 Black/African American adults and 816 Asian/Asian Pacific Islander adults. The rate of stable private insurance coverage was higher among white patients. Rates of public insurance, insurance switches and uninsured status were higher among Hispanic and black adults.

Hospitalizations occurred within 7.2% of the 6-month intervals. The rate of overall hospitalizations was higher among Black (8.3%) and Hispanic (8.5%) patients.

Hospitalization rates were higher among patients with stable public insurance (9.7%) compared with patients with private insurance (4.3%), insurance switches (8.3%) and those who were always uninsured (4.6%) within each racial/ethnic group. In addition, having stable public insurance was associated with significantly higher odds of hospitalization compared with having stable private insurance for each racial/ethnic group (OR = 2.12; 95% CI, 1.95-2.31).

Insurance switches were associated with significantly higher odds of hospitalization among non-Hispanic white patients (OR = 2.37; 95% CI, 2.01-2.8), Hispanic patients (OR = 1.74; 95% CI, 1.15-2.63) and Black/African American patients (OR = 1.86; 95% CI, 1.64-2.11) compared with patients with stable private insurance. White patients who were always uninsured were the only group with significantly higher hospitalization odds compared with patients with stable private insurance (OR = 1.52; 95% CI, 1.13-2.05).

The researchers reported no significant interaction between insurance stability and racial/ethnicity groups (P = .08).

“For patients with asthma, regardless of race or ethnicity, those with stable public insurance or insurance instability had increased odds of hospitalization ,” Sucharita Kher, MD, physician in the division of pulmonary, critical care and sleep medicine in the department of medicine at Tufts Medical Center and Tufts University School of Medicine, and colleagues wrote. “Insurance stability alone through Medicaid may be insufficient to prevent hospitalization in patients with asthma. Other social factors likely need to be addressed.”