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Child Health Evaluative Sciences

August 2014

Asthma Management, Socioeconomic Status, and Medication Insurance

Scientific Stories


It is well known that children from lower socio-economic status (SES) families have poorer asthma control. However, the specific role that medication cost-sharing, in the form of medication co-payments, has on asthma control has not been studied.


In this retrospective cohort study of 490 children with asthma, SES and medical history data were linked to administrative health-claims data on asthma emergency department (ED) visits and hospitalizations. Multiple Poisson regression identified independent variables associated with ED visits or hospitalizations in the full cohort and in a subgroup with prescription drug insurance.


In the full cohort, children from families with higher SES had 28 per cent fewer exacerbations than  children from low SES families. A key finding was that for every percentage point increase in the proportion of income that families had to spend out-of-pocket on asthma medications, there was a 14 per cent increase in exacerbations.


In families with drug plans,income level  andthe proportion of income consumed by asthma medication cost-sharing  both were a significant determinant of exacerbation. Drug plan policy makers must consider the relationship between medication cost-sharing and health outcomes to design better drug plans that promote favourable health outcomes.
Source: Ungar WJ, Paterson JM, Gomes T, Bikangaga P, Gold M, To T, Kozyrskyj AL. Relationship of asthma management, socioeconomic status, and medication insurance characteristics to exacerbation frequency in children with asthma. Annals of Allergy, Asthma & Immunology, 106:17–23, 2011.