Skip to main content
PMC home page
Public Health Reports logoLink to Public Health Reports
. 1999 Mar-Apr;114(2):135–148.

Effect of insurance coverage on the relationship between asthma hospitalizations and exposure to air pollution.

E Nauenberg 1, K Basu 1
PMCID: PMC1308453  PMID: 10199716

Abstract

OBJECTIVE: Based on the assumption that people without health insurance have limited access to the primary care services needed to prevent unnecessary hospitalizations for asthma, the authors hypothesized that insurance is a factor in the strength of the association between hospital admissions for asthma and exposure to air pollution. They tested this hypothesis with 1991-1994 data from central Los Angeles. METHODS: The authors analyzed the effect of insurance status on the association between asthma-related hospital admissions and exposure to atmospheric particulates (PM10) and ozone (O3) using hospital discharge and air quality data for 1991-1994 for central Los Angeles. They used regression techniques with weighted moving averages (simulating distributed lag structures) to measure the effects of exposure on overall hospital admissions, admissions of uninsured patients, admissions for which MediCal (California Medicaid) was the primary payer, and admissions for which the primary payer was another government or private health insurance program. RESULTS: No associations were found between asthma admissions and O3 exposure. An estimated increase from 1991 to 1994 of 50 micrograms per cubic meter in PM10 concentrations averaged over eight days was associated with an increase of 21.0% in the number of asthma admissions. An even stronger increase--27.4%--was noted among MediCal asthma admissions. CONCLUSIONS: The authors conclude that low family income, as indicated by MediCal coverage, is a better predictor of asthma exacerbations associated with air pollution than lack of insurance and, by implication, a better predictor of insufficient access to primary care.

Full text

PDF
137

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bates D. V., Baker-Anderson M., Sizto R. Asthma attack periodicity: a study of hospital emergency visits in Vancouver. Environ Res. 1990 Feb;51(1):51–70. doi: 10.1016/s0013-9351(05)80182-3. [DOI] [PubMed] [Google Scholar]
  2. Bates D. V., Sizto R. The Ontario Air Pollution Study: identification of the causative agent. Environ Health Perspect. 1989 Feb;79:69–72. doi: 10.1289/ehp.897969. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bindman A. B., Grumbach K., Osmond D., Komaromy M., Vranizan K., Lurie N., Billings J., Stewart A. Preventable hospitalizations and access to health care. JAMA. 1995 Jul 26;274(4):305–311. [PubMed] [Google Scholar]
  4. Burnett R. T., Dales R. E., Raizenne M. E., Krewski D., Summers P. W., Roberts G. R., Raad-Young M., Dann T., Brook J. Effects of low ambient levels of ozone and sulfates on the frequency of respiratory admissions to Ontario hospitals. Environ Res. 1994 May;65(2):172–194. doi: 10.1006/enrs.1994.1030. [DOI] [PubMed] [Google Scholar]
  5. Cookson W. O., Moffatt M. F. Asthma: an epidemic in the absence of infection? Science. 1997 Jan 3;275(5296):41–42. doi: 10.1126/science.275.5296.41. [DOI] [PubMed] [Google Scholar]
  6. Delfino R. J., Becklake M. R., Hanley J. A. The relationship of urgent hospital admissions for respiratory illnesses to photochemical air pollution levels in Montreal. Environ Res. 1994 Oct;67(1):1–19. doi: 10.1006/enrs.1994.1061. [DOI] [PubMed] [Google Scholar]
  7. Dockery D. W., Pope C. A., 3rd, Xu X., Spengler J. D., Ware J. H., Fay M. E., Ferris B. G., Jr, Speizer F. E. An association between air pollution and mortality in six U.S. cities. N Engl J Med. 1993 Dec 9;329(24):1753–1759. doi: 10.1056/NEJM199312093292401. [DOI] [PubMed] [Google Scholar]
  8. Gamble J. F., Lewis R. J. Health and respirable particulate (PM10) air pollution: a causal or statistical association? Environ Health Perspect. 1996 Aug;104(8):838–850. doi: 10.1289/ehp.96104838. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gergen P. J., Weiss K. B. Changing patterns of asthma hospitalization among children: 1979 to 1987. JAMA. 1990 Oct 3;264(13):1688–1692. [PubMed] [Google Scholar]
  10. Hexter A. C., Goldsmith J. R. Carbon monoxide: association of community air pollution with mortality. Science. 1971 Apr 16;172(3980):265–267. doi: 10.1126/science.172.3980.265. [DOI] [PubMed] [Google Scholar]
  11. Lang D. M., Polansky M. Patterns of asthma mortality in Philadelphia from 1969 to 1991. N Engl J Med. 1994 Dec 8;331(23):1542–1546. doi: 10.1056/NEJM199412083312302. [DOI] [PubMed] [Google Scholar]
  12. Lipfert F. W., Hammerstrom T. Temporal patterns in air pollution and hospital admissions. Environ Res. 1992 Dec;59(2):374–399. doi: 10.1016/s0013-9351(05)80043-x. [DOI] [PubMed] [Google Scholar]
  13. Ostro B. D. Associations between morbidity and alternative measures of particulate matter. Risk Anal. 1990 Sep;10(3):421–427. doi: 10.1111/j.1539-6924.1990.tb00525.x. [DOI] [PubMed] [Google Scholar]
  14. Pope C. A., 3rd, Bates D. V., Raizenne M. E. Health effects of particulate air pollution: time for reassessment? Environ Health Perspect. 1995 May;103(5):472–480. doi: 10.1289/ehp.95103472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Pope C. A., 3rd, Dockery D. W., Spengler J. D., Raizenne M. E. Respiratory health and PM10 pollution. A daily time series analysis. Am Rev Respir Dis. 1991 Sep;144(3 Pt 1):668–674. doi: 10.1164/ajrccm/144.3_Pt_1.668. [DOI] [PubMed] [Google Scholar]
  16. Pope C. A., 3rd Respiratory hospital admissions associated with PM10 pollution in Utah, Salt Lake, and Cache Valleys. Arch Environ Health. 1991 Mar-Apr;46(2):90–97. doi: 10.1080/00039896.1991.9937434. [DOI] [PubMed] [Google Scholar]
  17. Rosenstreich D. L., Eggleston P., Kattan M., Baker D., Slavin R. G., Gergen P., Mitchell H., McNiff-Mortimer K., Lynn H., Ownby D. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med. 1997 May 8;336(19):1356–1363. doi: 10.1056/NEJM199705083361904. [DOI] [PubMed] [Google Scholar]
  18. Schwartz J. Air pollution and hospital admissions for the elderly in Detroit, Michigan. Am J Respir Crit Care Med. 1994 Sep;150(3):648–655. doi: 10.1164/ajrccm.150.3.8087333. [DOI] [PubMed] [Google Scholar]
  19. Schwartz J., Slater D., Larson T. V., Pierson W. E., Koenig J. Q. Particulate air pollution and hospital emergency room visits for asthma in Seattle. Am Rev Respir Dis. 1993 Apr;147(4):826–831. doi: 10.1164/ajrccm/147.4.826. [DOI] [PubMed] [Google Scholar]
  20. Thurston G. D., Gorczynski J. E., Jr, Currie J. H., He D., Ito K., Hipfner J., Waldman J., Lioy P. J., Lippmann M. The nature and origins of acid summer haze air pollution in metropolitan Toronto, Ontario. Environ Res. 1994 May;65(2):254–270. doi: 10.1006/enrs.1994.1036. [DOI] [PubMed] [Google Scholar]
  21. Thurston G. D., Ito K., Kinney P. L., Lippmann M. A multi-year study of air pollution and respiratory hospital admissions in three New York State metropolitan areas: results for 1988 and 1989 summers. J Expo Anal Environ Epidemiol. 1992 Oct-Dec;2(4):429–450. [PubMed] [Google Scholar]
  22. Weiss K. B., Gergen P. J., Crain E. F. Inner-city asthma. The epidemiology of an emerging US public health concern. Chest. 1992 Jun;101(6 Suppl):362S–367S. doi: 10.1378/chest.101.6.362s. [DOI] [PubMed] [Google Scholar]
  23. Weissman J. S., Stern R., Fielding S. L., Epstein A. M. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991 Feb 15;114(4):325–331. doi: 10.7326/0003-4819-114-4-325. [DOI] [PubMed] [Google Scholar]
  24. Wissow L. S., Gittelsohn A. M., Szklo M., Starfield B., Mussman M. Poverty, race, and hospitalization for childhood asthma. Am J Public Health. 1988 Jul;78(7):777–782. doi: 10.2105/ajph.78.7.777. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Wordley J., Walters S., Ayres J. G. Short term variations in hospital admissions and mortality and particulate air pollution. Occup Environ Med. 1997 Feb;54(2):108–116. doi: 10.1136/oem.54.2.108. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES