TOPLINE:

In the United States, cost barriers to asthma care among adults varied by insurance coverage and were influenced by demographic, socioeconomic, and clinical factors. Although individuals with partial or no insurance coverage faced greater cost barriers, fully insured subgroups — such as non-Hispanic Black individuals — also encountered significant financial challenges in accessing asthma care.

METHODOLOGY:

• Researchers conducted a cross-sectional study to identify predictors of cost barriers among adults with asthma in the United States, examining differences both between and within groups with full insurance and those with partial or no insurance.
• They analyzed 25,996 adults — 86.31% with full-year insurance coverage and 13.69% with partial or no coverage — using data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System Survey from 2019 to 2021.
• Self-reported insurance coverage was assessed by classifying individuals as having “full-year coverage” if they were insured for the entire last year, “partial coverage” if they were insured for only part of the last year, and “no coverage” if they were uninsured. Those with partial or no coverage were grouped together for analysis.
• The primary outcome was the presence of any cost barrier in one of the following three categories: Barriers to primary care, barriers to care by asthma specialists, and barriers to asthma medications.
• The predictors of cost barriers were chosen that included demographic, socioeconomic, and clinical characteristics.

TAKEAWAY:

• Cost barriers to primary care were higher among those with at least one emergency department visit in the last year (odds ratio [OR], 2.59), Hispanic ethnicity (adjusted OR [aOR], 1.49), and residence in nonmetro areas (aOR, 1.43). Among fully insured individuals, Black race (aOR, 1.91) and a recent emergency department visit (aOR, 3.33) significantly increased cost barriers to primary care.
• Overall, higher-income individuals were less likely to face cost barriers to care by asthma specialists (aOR, 0.33; 95% CI, 0.19-0.55). Conversely, in both groups, those with at least one emergency department visit or hospitalization in the last year were three times more likely to encounter these cost barriers (aOR, 3.37; 95% CI, 2.37-4.79).
• Men, regardless of insurance status (overall aOR, 0.69; 95% CI, 0.57-0.85), and older individuals with full-year insurance coverage (aOR, 0.64; 95% CI, 0.49-0.84) were less likely to face cost barriers to asthma medications.
• Overall, the likelihood of having any cost barriers was lower among women, older adults, individuals with higher incomes, and those whose most recent asthma symptoms had occurred more than a year ago.

IN PRACTICE:

“These findings emphasize the importance of targeted policy and practice strategies to overcome cost barriers in order to reduce disparities and improve asthma care,” the authors wrote.

SOURCE:

This study was led by Luyu Xie, PhD, University of Texas Southwestern Medical Center, Dallas. It was published online on March 25, 2025, in The Journal of Allergy and Clinical Immunology: In Practice.

LIMITATIONS:

The cross-sectional design of this study limited the ability to draw causal inferences and may have introduced residual confounding. Although the sample was diverse, the self-reported nature of insurance status and the survey design may have introduced recall and nonresponse bias, limiting the generalizability of the findings. The researchers could not account for all social determinants of health, specific types of insurance, or health system factors.

DISCLOSURES:

This study did not receive any funding support. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.