1. Children with asthma with private insurance disproportionately affected by the COVID-19 pandemic in terms of indoor asthma triggers, reduced income and housing insecurity

2. Families with public insurance also more likely to test positive for SARS-CoV-2

Evidence Rating Level: 2 (Good)

The COVID-19 pandemic has had an impact on healthcare utilization patterns as well as total number of emergency department visits in the USA. Emergency room visits in New York City (NYC) for asthma, one of the most common chronic conditions in children, decreased by 92% in the 12 weeks following NYC’s stay at home orders compared to the same time from in the prior year. Those in low-income neighborhoods such as East Harlem, NYC are disproportionately affected by asthma morbidity and were also severely affected by the high burden of COVID-19. This cross-sectional survey included families from two sites that care for children who have asthma that were geographically close but from distinct neighborhoods. These sites were East Harlem and Upper East Side. East Harlem is a high-poverty neighborhood, with 23% of residents living in poverty, whereas the Upper East Side is a low-poverty neighborhood, with only 7% of residents living in poverty. A phone survey was conducted by families who had children treated for asthma between 5-18 years of age and a primary address within the two neighborhoods. Participants were also stratified into whether their health insurance was private or public (Medicaid). The study found that those with public health insurance had significantly higher reports of indoor asthma triggers (cockroach 76% vs 23%; mold 40% vs 12%), reduced income (72% vs 27%), and housing insecurity (32% vs 0%), and were also more likely to experience conditions less suitable to social distancing. The families with public insurance were also more likely to test positive for COVID-19, but less likely to get tested (48% vs 15% and 76% vs 100% respectively). Those with public insurance had greater challenges in accessing medical care and telehealth but not at statistically significant levels. Limitations to this study include sample size as well as recall bias. However, this study does highlight that insurance type is associated with disparities in healthcare for those with asthma due to the COVID-19 pandemic. Further studies investigating barriers to care as well as ways to support those who experience these barriers are needed to help support the health and well-being of children with asthma.

Click to read the study in BMC Pediatrics

Image: PD

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