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Health Insurance Status and Access to Healthcare Among Young Adults with Congenital Heart Disease: from the Congenital Heart Survey To Recognize Outcomes, Needs and Well-beinG (CH STRONG), 2016–2019

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Abstract

Having health insurance is associated with better access to healthcare and lower rates of comorbidity in the general population, but data are limited on insurance’s impact on adults with congenital heart disease (ACHD). The Congenital Heart Survey To Recognize Outcomes, Needs and well-beinG (CH STRONG) was conducted among ACHD in three locations from 2016 to 2019. We performed multivariable logistic regression to determine the associations between health insurance and both access to healthcare and presence of comorbidities. We also compared health insurance and comorbidities among ACHD to similarly-aged individuals in the Behavioral Risk Factor Surveillance System (BRFSS) as a proxy for the general population. Of 1354 CH STRONG respondents, the majority were ≤ 30 years old (83.5%), and 8.8% were uninsured versus 17.7% in the BRFSS (p < 0.01). Compared to insured ACHD, uninsured were less likely to report regular medical care (adjusted odds ratio [aOR] 0.2, 95% confidence interval [CI] 0.1–0.3) and visited an emergency room more often (aOR 1.6, CI 1.0–2.3). Among all ACHD reporting disability, uninsured individuals less frequently received benefits (aOR 0.1, CI 0.0–0.3). Depression was common among uninsured ACHD (22.5%), but insured ACHD had lower rates of depression than insured in the BRFSS (13.3% vs. 22.5%, p < 0.01). In conclusion, rates of insurance were higher among ACHD compared to the general population. Nonetheless, uninsured ACHD inconsistently accessed healthcare and benefits. Further studies are needed to determine if insurance ameliorates the risk of morbidity as ACHD age.

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Funding

The present study was supported in part by a Grant from the March of Dimes and Centers for Disease Control (# U38O2000199).

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Authors and Affiliations

  1. Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, 1 Children’s Way, Box 512-3, Little Rock, AR, 72202, USA

    Elijah H. Bolin & Wendy N. Nembhard

  2. Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Mir M. Ali

  3. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Sherry L. Farr & Matthew E. Oster

  4. Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA

    Matthew E. Oster

  5. Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA

    Scott E. Klewer & Michael D. Seckeler

  6. Departments of Pediatrics and Internal Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Stanford, CA, USA

    R. Collins Thomas II

  7. Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, USA

    Wendy N. Nembhard

Authors
  1. Elijah H. Bolin
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  2. Mir M. Ali
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  4. Matthew E. Oster
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  7. Michael D. Seckeler
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Contributions

EHB, WNN, MDS, RTC, SEK, SLF, and MEO wrote the main manuscript. MMA performed statistical analyses and wrote sections pertaining to statistical methodology. All authors reviewed the manuscript.

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Correspondence to Elijah H. Bolin.

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Bolin, E.H., Ali, M.M., Farr, S.L. et al. Health Insurance Status and Access to Healthcare Among Young Adults with Congenital Heart Disease: from the Congenital Heart Survey To Recognize Outcomes, Needs and Well-beinG (CH STRONG), 2016–2019. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03106-z

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