Differences in health care access and utilization between adolescents and young adults with asthma

Abstract

Objective: Studies suggest that young adults have worse health care access, use less primary care, and visit emergency departments more frequently than adolescents. We examined whether these differences existed between older adolescents and young adults with asthma.

Methods: Using nationally representative data from the 1999 to 2009 Medical Expenditure Panel Survey, we performed cross-sectional comparisons of access and utilization between older adolescents (ages 14-17) and young adults (ages 19-25) with asthma. In longitudinal analyses, we assessed whether changes in health insurance coverage, schooling, and adult presence at home predicted changes in access and utilization.

Results: Young adults with asthma were less likely to have a usual source of care (-13.7 percentage points; P < .001) or primary care visit within the past year (-13.9 percentage points; P = .006). They were less likely to fill a short-acting beta-agonist prescription (-10.6 percentage points; P = .02) and more likely to visit the emergency department within the past year (+9.7 percentage points; P = .01). Adjusting for differences in insurance coverage reduced differences in usual source of care and primary care use by 32.4% to 38.0% but reduced the difference in emergency department use by only 10.3%. Among participants aged 16 to 19 in the first survey year, becoming uninsured strongly predicted losing a usual source of care (change relative to no coverage loss: -25.2 percentage points; P = .003).

Conclusions: Compared with older adolescents with asthma, young adults with asthma have worse health care access and may use care less optimally. These differences were associated with but were not completely explained by differences in insurance coverage.

Keywords: adolescents; asthma; health care utilization; health insurance; young adult.

FIGURE 1

Health care access and utilization among older adolescents and young adults with asthma. Panels A to H display age-specific means and fitted regression lines for each of the 8 dependent variables in cross-sectional comparisons: A, Usual source of care; B, ≥1 primary care visit in the previous 12 months; C, ≥1 preventive visit in the previous 12 months; D, ≥1 fill of a short-acting beta-agonist prescription in the previous 12 months; E, ≥1 fill of a controller medication prescription in the previous 12 months; F, ≥1 ED visit in the previous 12 months; G, cost or coverage-related problem accessing medical care in the previous 12 months; H, cost or coverage-related problem accessing medications in the previous 12 months. The square data points represent excluded data for participants aged 18.

APPENDIX FIGURE 1

Age-specific asthma prevalence in cross-sectional sample, MEPS 1999–2009.

APPENDIX FIGURE 2

Changes in health insurance coverage, schooling, and adult presence at home among participants aged 14 to 25 with asthma, MEPS 1999–2009. A, Percentage of months with health insurance coverage; B, percentage of participants who were full-time students for all or most of the year; C, percentage of participants who had a continuous adult presence at home for all or most of the year. Student status information was collected only from participants aged 17 to 23 in the MEPS. To construct the graph of changes in schooling, we assumed that all participants aged 14 to 16 were full-time students and excluded data from participants aged 24 to 25. Using data from MEPS rounds 1 to 3 or 3 to 5, we classified participants as full-time students for all or most of the year if they were full-time students at the end of at least 2 of the 3 rounds. We applied similar criteria to identify participants with continuous adult presence at home for all or most of the year. To classify the small number of participants with missing data for schooling or adult presence at home, we used the rounds for which data were available for these individuals. The square data points represent excluded data for participants aged 18.