The Impact of Tobacco Smoke Exposure on Childhood Asthma in a Medicaid Managed Care Plan
The Impact of Tobacco Smoke Exposure on Childhood Asthma in a Medicaid Managed Care Plan
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DOI：
10.1378/chest.15-1378
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发表时间：
2016-03-01
期刊：
影响因子：
9.6
通讯作者：
Giardino, Angelo P.
中科院分区：
文献类型：
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作者：
Farber, Harold J.;Batsell, Richard R.;Giardino, Angelo P.
背景：烟草烟雾暴露会增加儿童的呼吸问题。德克萨斯州儿童健康计划是一个管理医疗补助和儿童健康保险计划（CHIP）管理的医疗服务提供者。本研究的目的是确定烟草烟雾暴露，哮喘患病率和哮喘卫生保健utilization.METHODS：德克萨斯州儿童健康计划进行了年度调查的成员谁有一个医生访问之间的关联。2010年3月，调查中增加了关于哮喘和烟草烟雾暴露的问题。对18岁以下儿童的调查结果与医生就诊日期后12个月的健康计划索赔数据相匹配。结果：共有22，470名从出生到18岁以下的独特成员/患者的父母参加了调查。白人比非洲裔美国人或西班牙裔美国人更多地报告孩子的母亲是吸烟者（分别为19.5%对9.1%和2.3%; P <0.001）。与母亲不吸烟的儿童相比，如果母亲是吸烟者，则父母报告哮喘诊断和要求分发短效β受体激动剂药物的比例更高（校正OR分别为1.20 [95%CI，1.03-1.40]和1.24 [95%CI，1.08-1.42]）。与没有自付费用的医疗补助计划相反，CHIP业务线要求艾德就诊的共同负担费用。艾德就诊仅在CHIP业务线中受母亲吸烟的影响（调整OR，4.40; 95%CI，1.69-11.44）。结论：母亲吸烟增加了哮喘诊断和哮喘快速缓解药物处方的风险。母亲吸烟仅预测CHIP业务线的哮喘相关艾德就诊。
BACKGROUND: Tobacco smoke exposure increases breathing problems of children. Texas Children's Health Plan is a Managed Medicaid and Children's Health Insurance Program (CHIP) managed care provider. The aim of this study is to determine associations among tobacco smoke exposure, asthma prevalence, and asthma health-care utilization.METHODS: Texas Children's Health Plan conducts an annual survey of members who have a physician visit. Questions were added to the survey in March 2010 about asthma and tobacco smoke exposure. Survey results for children < 18 years of age were matched to health plan claims data for the 12 months following the date of the physician visit.RESULTS: A total of 22,470 parents of unique members/patients from birth to < 18 years of age participated in the survey. More whites than African Americans or Hispanics report that the child's mother is a smoker (19.5% vs 9.1% and vs 2.3%, respectively; P < .001). Compared with children whose mother does not smoke, parent report of asthma diagnosis and claims for dispensing of short-acting beta agonist medication are greater if the mother is a smoker (adjusted OR, 1.20 [95% CI, 1.03-1.40] and 1.24 [95% CI, 1.08-1.42], respectively). In contrast to Medicaid, in which there are no out-of-pocket costs, the CHIP line of business requires copays for ED visits. ED visits are influenced by maternal smoking only in the CHIP line of business (adjusted OR, 4.40; 95% CI, 1.69-11.44).CONCLUSION: Maternal smoking increases risk for asthma diagnosis and prescription of asthma quick relief medication. Maternal smoking predicted asthma-related ED visits only for the CHIP line of business.