A Canadian study finds that financial barriers are contributing to poor asthma control in children. The study, the first to examine the effects of medication cost-sharing between insurers and families as a percentage of household income on health outcomes in children with asthma, appears in the Annals of Allergy, Asthma & Immunology.
Recognizing the low rate of asthma control in Canadian children, the researchers set out to examine the factors that contributed to severe asthma attacks resulting in emergency department visits or hospitalizations in children.
The cohort study looked at data from 490 Toronto-area children aged 1 to 18 years of age with asthma. The research team was particularly interested in the relationship of certain demographic factors—including socioeconomic status, health status, health resource use, symptoms, and drug coverage—to asthma control.
The findings showed that in the subgroup of drug-plan holders every 1% increase in family income spent out-of-pocket on a child’s asthma medications, there was a 14% increase in the number of severe asthma attacks resulting in an emergency room visit or hospital admission.
The research team found the following factors were significantly associated with more frequent asthma attacks requiring urgent care: younger age; previous emergency visits; nebulizer use; pet ownership; and having asthma education, but no management or action plan. Having an asthma action plan was found to significantly reduce the number of severe asthma attacks. Moreover, children from families with high income adequacy, a measure that combines household income with family size, had 28% fewer severe asthma attacks than children with low income adequacy.
In addition to the above findings, the researchers looked at a subgroup within the data sample, all of whom had drug insurance, and found that girls had 26% fewer exacerbations than boys. Children in this subgroup with food, drug, or insect allergies also had 52% more severe asthma attacks than did children without allergies. Meanwhile, children of families with annual insurance deductibles greater than $90 had 95% fewer exacerbations.