Increased Mortality in Adult Cystic Fibrosis Patients with Medicaid Insurance Awaiting Lung Transplantation

Abstract

CF patients with Medicaid insurance have higher risk of death while awaiting LTx when compared to patients with Medicare or private insurance. The impact of insurance status on survival in this population begins before LTx and compounds the disparities previously observed in post-transplant outcomes.

Opportunities for Outpatient Pharmacy Services for Patients with Cystic Fibrosis: Perceptions of Healthcare Team Members

“…In handling medication access challenges, study participants explained that issues with prior authorizations were time consuming and caused delays in patients receiving their CF medications. A previous study found that insurance prominently impacts the health of patients with CF, where patients who had Medicaid or public insurance had a higher risk of death while waiting for a lung transplant than those who had private or Medicare insurance [22]. A previous study shows pharmacists are well-positioned to address prior authorization and insurance coverage challenges that burden existing CF care team workload [23].…”

Defining Success in Lung Transplantation: From Survival to Quality of Life

“…In the United States, patients with cystic fibrosis who had Medicaid as their primary insurance had higher rates of death on the waiting list compared with those with private insurance. 80 This finding, however, did not extend to all patients on government sponsored insurance, as cystic fibrosis patients with insurance through the United Kingdom's National Health Service had similar outcomes to patients with private insurance. 81 It is unclear why cystic fibrosis patients on Medicaid are less likely to survive to transplant than patients on private insurance; however, it may be due to access to care.…”

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

“…Estimates were combined across imputations as previously described. 7,22 Time-varying covariates were calendar year; current age in years; educational attainment (high school or less, some college or college graduate); marital status (single, married/living together, separated/ divorced/widowed); employment; CF-related diabetes; smoking status; body mass index (underweight, <18.5 kg/m 2 ; normal weight, 18.5-24.9 kg/m 2 ; overweight, 25 kg/m 2 ); forced expiratory volume in 1 second (FEV1% predicted: mild/no obstruction, 80%; moderate obstruction, 50-79%; severe obstruction, <50%); number of pulmonary exacerbations (PEx) requiring intravenous (IV) antibiotics; confirmed Burkholderia cepacia infection and lung transplantation. 20 Stata/IC 13.1 (StataCorp LP, College Station, Texas) was used for data analysis, and P < .05 was considered statistically significant.…”

“…Because of this changing age composition, it is crucial to understand how access to specialty care can be preserved for CF patients aging into adulthood, particularly given the strong impact socioeconomic status (SES) disparities have on clinical outcomes of CF . In the United States, access to medical care improved after implementation of the Patient Protection and Affordable Care Act (ACA), but public health insurance (especially Medicaid) remains linked to worse outcomes for many chronic diseases . Yet, studies in the pediatric CF population found that public health insurance did not influence access to CF care, meaning that SES disparities in outcomes were attributable to other mechanisms, such as disease self‐management, exposure to pollutants and emotional well‐being.…”

“…[3][4][5] In the United States, access to medical care improved after implementation of the Patient Protection and Affordable Care Act (ACA), 6 but public health insurance (especially Medicaid) remains linked to worse outcomes for many chronic diseases. 7,8 Yet, studies in the pediatric CF population found that public health insurance did not influence access to CF care, 9,10 meaning that SES disparities in outcomes were attributable to other mechanisms, such as disease self-management, exposure to pollutants and emotional well-being. Relationships between SES and access to routine CF care are unclear in adults.…”