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

Susan S. Li, Don Hayes, Joseph D. Tobias, Wayne J. Morgan, Dmitry Tumin

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Low 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. Methods: Patients ≥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. Results: A total of 18 358 patients contributed 94 690 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). Conclusions: For 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.

Original languageEnglish (US)
Pages (from-to)1981-1988
Number of pages8
JournalClinical Respiratory Journal
Issue number5
StatePublished - May 2018


  • Medicaid
  • Medicare
  • access to care
  • health care disparities
  • health insurance

ASJC Scopus subject areas

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine
  • Genetics(clinical)


Dive into the research topics of 'Health insurance and use of recommended routine care in adults with cystic fibrosis'. Together they form a unique fingerprint.

Cite this