Perceived Parent Financial Burden and Asthma Outcomes in Low-Income, Urban Children

Abstract

The purpose of this study was to describe the demographic characteristics of low-income parents who perceive financial burden in managing their child's asthma and related associations with their children's asthma outcomes and clinical characteristics. We hypothesized that (1) identifiable differences between parents who do and do not report burden; (2) regardless of access to care, asthma outcomes would be worse for children whose parents perceive financial burden in obtaining care for their child's condition. Baseline data from a randomized trial evaluating the effect of a school-based asthma intervention were analyzed for this research. Eight hundred thirty-five parents were interviewed by telephone regarding their child's asthma management. Associations between demographic and clinical factors and perception of financial burden were examined using bivariate analysis. Multivariate regression analyses were used to examine associations between perceptions of financial burden and asthma outcomes, including emergency department visits, hospitalizations, and missed school days. Perceived financial burden was evident in 10 % (n079) of parents. Female heads of household (χ 2 (3)07.41; pG0.05), those at the lowest income levels (χ 2 (3)012.14; pG0.01), and those whose child's asthma was poorly controlled (χ 2 (2)049.42; pG0.001) were most likely to perceive financial burden. In models controlling for level of asthma control, income, and having a usual source of asthma care, parents who perceived financial burden were more likely to have children who had at least one emergency department visit (OR01.95; 95 % CI01.15 to 3.29), hospitalization (OR03.99; 95 % CI02.03 to 7.82), or missed school days due to asthma (OR03.26; 95 % CI01.60 to 6.67) in the previous year. Our results supported our hypotheses. Among low-income parents of children with asthma, the majority do not perceive financial burden to obtaining care. However, among parents that do perceive burden, urgent care use and missed school days due to asthma for their child were significantly higher, regardless of family income and having a usual source of asthma care. Mothers and grandmothers heading families and those caring for children with uncontrolled asthma were most likely to report burden. These findings have implications for clinical practice in that health care providers may be able to take simple actions to determine patients' financial-related perceptions, correct misconceptions, and help patients consider their full range of options to manage their child's asthma.

Social Disadvantage and Asthma Control in Children

“…This increase in exacerbations and absenteeism was independent of disease severity, access to healthcare, and the actual financial status of the family. 10 This highlights a key role for parental perception of the social situation and indicates that there is likely a complex interplay between the actual financial climate in the home and the perceived threat of that climate, which is ultimately influencing health outcomes among asthmatic children.…”

Stress and Quality of Life in Urban Caregivers of Children With Poorly Controlled Asthma: A Longitudinal Analysis

“…The burden of asthma exacerbations likewise reverberates throughout families who describe substantial psychosocial, caregiving, and financial stresses (Crespo, Carona, Silva, Canavarro, & Dattilio, 2011; Sampson et al, 2013a; Sampson et al, 2013b), beyond the fear of seeing their child struggling to breathe. Not surprising, caregivers of children with poorly controlled asthma report more missed work compared to caregivers of children with controlled asthma (31% vs. 16%) (Dean, et al 2009), decreased work productivity, with an average of 4.1 hours of productivity loss over a 40 hour work week during their child's asthma episode (Dean, et al, 2010), and higher perceived financial burden than caregivers of children with well controlled asthma (Patel, Brown, & Clark, 2013). …”

Socioeconomic status and asthma control in African American youth in SAGE II

“…Moreover, individuals with low educational attainment have reduced insurance coverage which can limit optimal access to healthcare (9, 10). Lastly, households in the lowest income levels are more likely to perceive financial burden in managing their child’s asthma, have higher rates of urgent care use, and experience missed school days due to asthma (11). …”