Health insurance and use of recommended routine care in adults with cystic fibrosis

BackgroundLow socioeconomic status is correlated with worse outcomes in patients with cystic fibrosis (CF). Whether insurance status impacts adherence to care in this population is unknown. MethodsPatients 18 years old in the CF Foundation Patient Registry (2005-2013) were grouped based on reported annual insurance as private, public (Medicaid, Medicare or state medical assistance program), others or no insurance. Random effects logistic regression evaluated association between change in insurance status and annual use of recommended routine care. ResultsA total of 18358 patients contributed 94690 years of data to the analysis. In descriptive analysis, adherence to recommended routine care (4 clinic visits, 4 respiratory cultures and 2 pulmonary function tests per year) and recommended chronic medications for those with moderate to severe lung disease (dornase alfa and inhaled tobramycin or aztreonam if Pseudomoas aeruginosa in respiratory cultures) was most common in public insurance compared to other insurance types. In multivariable logistic regression, public insurance was associated with greater use of recommended care relative to private insurance (OR=1.16; 95% confidence interval: 1.10-1.22; P<.001), while being uninsured was associated with lower odds of using recommended care (OR=0.37; 95% confidence interval: 0.31-0.46; P<.001). ConclusionsFor adults with CF in the United States, public insurance was associated with greater use of routine care than private coverage. Being uninsured was strongly associated with not using routine care. Further efforts to improve access to CF care should address the feasibility of universal and continuous insurance coverage in the CF population.