TY - JOUR
T1 - Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD
T2 - Findings From the CKiD Cohort Study
AU - Chronic Kidney Disease in Children Study
AU - Molino, Andrea R.
AU - Minnick, Maria Lourdes G.
AU - Jerry-Fluker, Judith
AU - Karita Muiru, Jacqueline
AU - Boynton, Sara A.
AU - Furth, Susan L.
AU - Warady, Bradley A.
AU - Ng, Derek K.
N1 - Funding Information:
The CKiD Study is funded by the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01DK66143, U01DK66174, U24DK082194, U24DK66116).
Funding Information:
Andrea R. Molino, ScM, Maria Lourdes G. Minnick, PhD, Judith Jerry-Fluker, MPH, Jacqueline Karita Muiru, MPH, Sara A. Boynton, MPH, Susan L. Furth, MD, PhD, Bradley A. Warady, MD, and Derek K. Ng, PhD on behalf of the Chronic Kidney Disease in Children Study, A full list of CKiD Investigators is provided in Item S1. research idea and study design: ARM, MLGM, DKN; data acquisition: JKM, SAB, SLF, BAW; data analysis/interpretation: ARM, JJF, DKN; statistical analysis: ARM, DKN; supervision and/or mentorship: JJF, SLF, BAW, DKN. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. The CKiD Study is funded by the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01DK66143, U01DK66174, U24DK082194, U24DK66116). The authors declare that they have no relevant financial interests. Data in this manuscript were collected by the Chronic Kidney Disease in Children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children's Mercy Hospital and the University of Missouri – Kansas City (Bradley Warady, MD) and Children's Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD and Derek Ng, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD website is located at https://statepi.jhsph.edu/ckid and a list of CKiD collaborators can be found at https://statepi.jhsph.edu/ckid/site-investigators/. Received October 6, 2021. Evaluated by 3 external peer reviewers, with direct editorial input from the Statistical Editor and the Editor-in-Chief. Accepted in revised form February 14, 2022.
Publisher Copyright:
© 2022 The Authors
PY - 2022/5
Y1 - 2022/5
N2 - 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.
AB - 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.
KW - Chronic kidney disease
KW - dental health
KW - dental insurance
KW - epidemiology
KW - health care utilization
KW - health insurance
KW - pediatric nephrology
KW - socioeconomic markers
KW - socioeconomic position
UR - http://www.scopus.com/inward/record.url?scp=85130905745&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85130905745&partnerID=8YFLogxK
U2 - 10.1016/j.xkme.2022.100455
DO - 10.1016/j.xkme.2022.100455
M3 - Article
C2 - 35518833
AN - SCOPUS:85130905745
SN - 2590-0595
VL - 4
JO - Kidney Medicine
JF - Kidney Medicine
IS - 5
M1 - 100455
ER -