Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort StudyPlain-Language Summary
Rationale & Objective: To understand the association between health and dental insurance status and health and dental care utilization, and their relationship with disease severity in a population with childhood-onset chronic kidney disease (CKD). Study Design: Observational cohort study. Se...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-05-01
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| Series: | Kidney Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059522000681 |
| _version_ | 1828345285049319424 |
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| author | Andrea R. Molino Maria Lourdes G. Minnick Judith Jerry-Fluker Jacqueline Karita Muiru Sara A. Boynton Susan L. Furth Bradley A. Warady Derek K. Ng |
| author_facet | Andrea R. Molino Maria Lourdes G. Minnick Judith Jerry-Fluker Jacqueline Karita Muiru Sara A. Boynton Susan L. Furth Bradley A. Warady Derek K. Ng |
| author_sort | Andrea R. Molino |
| collection | DOAJ |
| description | Rationale & Objective: To understand the association between health and dental insurance status and health and dental care utilization, and their relationship with disease severity in a population with childhood-onset chronic kidney disease (CKD). Study Design: Observational cohort study. Settings & Participants: Nine hundred fifty-three participants contributing 4,369 person-visits (unit of analysis) in the United States enrolled in the Chronic Kidney Disease in Children (CKiD) Study from 2005 to 2019. Exposures: Health insurance (private vs public vs none) and dental insurance (presence vs absence) self-reported at annual visits. Outcomes: Self-reported suboptimal health care utilization in the past year, defined separately as not visiting a private physician, visiting the emergency room, visiting the emergency room at least twice, being hospitalized, and self-reported suboptimal dental care utilization over the past year, defined as not receiving dental care. Analytical Approach: Repeated measures Poisson regression models were fit to estimate and compare utilization by insurance type and disease severity at the prior visit. Additional unadjusted and adjusted models were fit, as well as models including interactions between insurance and Black race, maternal education, and income. Results: Those with public health insurance were more likely to report suboptimal health care utilization across the CKD severity spectrum, and lack of dental insurance was strongly associated with lack of dental care. These relationships varied depending on strata of socioeconomic status and race but the effect measure modification was not significant. Limitations: Details of insurance coverage were unavailable; reasons for emergency care or type of private physician visited were unknown. Conclusions: Pediatric nephrology programs may consider interventions to help direct supportive resources to families with public insurance who are at higher risk for suboptimal utilization of care. Insurance providers should identify areas to expand access for families of children with CKD. |
| first_indexed | 2024-04-14T00:08:33Z |
| format | Article |
| id | doaj.art-5224f82d97c646cfab3abae2de1b5c08 |
| institution | Directory Open Access Journal |
| issn | 2590-0595 |
| language | English |
| last_indexed | 2024-04-14T00:08:33Z |
| publishDate | 2022-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj.art-5224f82d97c646cfab3abae2de1b5c082022-12-22T02:23:25ZengElsevierKidney Medicine2590-05952022-05-0145100455Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort StudyPlain-Language SummaryAndrea R. Molino0Maria Lourdes G. Minnick1Judith Jerry-Fluker2Jacqueline Karita Muiru3Sara A. Boynton4Susan L. Furth5Bradley A. Warady6Derek K. Ng7Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Address for Correspondence: Andrea R. Molino, ScM, 615 N. Wolfe Street Rm. E7010, Baltimore, MD 21075.Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PADepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MDDepartment of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PADepartment of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MDDepartment of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PADepartment of Pediatrics, Division of Nephrology, Children’s Mercy Kansas City, Kansas City, MODepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MDRationale & Objective: To understand the association between health and dental insurance status and health and dental care utilization, and their relationship with disease severity in a population with childhood-onset chronic kidney disease (CKD). Study Design: Observational cohort study. Settings & Participants: Nine hundred fifty-three participants contributing 4,369 person-visits (unit of analysis) in the United States enrolled in the Chronic Kidney Disease in Children (CKiD) Study from 2005 to 2019. Exposures: Health insurance (private vs public vs none) and dental insurance (presence vs absence) self-reported at annual visits. Outcomes: Self-reported suboptimal health care utilization in the past year, defined separately as not visiting a private physician, visiting the emergency room, visiting the emergency room at least twice, being hospitalized, and self-reported suboptimal dental care utilization over the past year, defined as not receiving dental care. Analytical Approach: Repeated measures Poisson regression models were fit to estimate and compare utilization by insurance type and disease severity at the prior visit. Additional unadjusted and adjusted models were fit, as well as models including interactions between insurance and Black race, maternal education, and income. Results: Those with public health insurance were more likely to report suboptimal health care utilization across the CKD severity spectrum, and lack of dental insurance was strongly associated with lack of dental care. These relationships varied depending on strata of socioeconomic status and race but the effect measure modification was not significant. Limitations: Details of insurance coverage were unavailable; reasons for emergency care or type of private physician visited were unknown. Conclusions: Pediatric nephrology programs may consider interventions to help direct supportive resources to families with public insurance who are at higher risk for suboptimal utilization of care. Insurance providers should identify areas to expand access for families of children with CKD.http://www.sciencedirect.com/science/article/pii/S2590059522000681Chronic kidney diseasedental healthdental insuranceepidemiologyhealth care utilizationhealth insurance |
| spellingShingle | Andrea R. Molino Maria Lourdes G. Minnick Judith Jerry-Fluker Jacqueline Karita Muiru Sara A. Boynton Susan L. Furth Bradley A. Warady Derek K. Ng Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort StudyPlain-Language Summary Kidney Medicine Chronic kidney disease dental health dental insurance epidemiology health care utilization health insurance |
| title | Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort StudyPlain-Language Summary |
| title_full | Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort StudyPlain-Language Summary |
| title_fullStr | Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort StudyPlain-Language Summary |
| title_full_unstemmed | Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort StudyPlain-Language Summary |
| title_short | Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort StudyPlain-Language Summary |
| title_sort | health and dental insurance and health care utilization among children adolescents and young adults with ckd findings from the ckid cohort studyplain language summary |
| topic | Chronic kidney disease dental health dental insurance epidemiology health care utilization health insurance |
| url | http://www.sciencedirect.com/science/article/pii/S2590059522000681 |
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