Disparities in insurance status
Studies focusing specifically on respiratory diseases and outcomes at
the PICU based on the type of insurance status are scarce. Lopez et al.
performed a large multicenter study of critically ill patients admitted
at the PICU and found no differences in outcome (assessing mortality
rates and overall resource use) regarding to sex, race and insurance
status, after adjusting for illness severity15. One of
the limitations of this study was the underrepresentation of ethnic
minorities. Nevertheless, they did demonstrate that uninsured children
had the highest rate of mechanical ventilation15. This
data is supported by the findings in this review where Bratton et al.
showed an increased use of mechanical ventilation in children with a
public health insurance33. However, they also
demonstrated a longer length of stay at the PICU in children admitted
with asthma33. In addition, Silber et al. described a
prolonged PICU LOS in patients admitted with asthma with a public health
insurance34. These reported outcomes are possibly
related with the use, quality and availability of primary health
care15,33.