RELATIONSHIP BETWEEN SOCIOECONOMIC-STATUS AND DISEASE SEVERITY IN CYSTIC-FIBROSIS

Objective: This study tvas carried out to evaluate whether patients wi th cystic fibrosis (CF) who are socioeconomically disadvantaged, have a different outcome than higher-income patients, Medicaid insurance co verage was used as a proxy of low family income. Study design: A cross -sectional analysis sas performed on a group of patients younger than 21 years of age seen at the University of North Carolina CF Center in 1994. Results: The difference in median age al diagnosis for Medicaid (132 days) and non-Medicaid (177 days) patients uas not statistically significant (p = 0.17). Medicaid patients' mean maximum percent predic ted forced expiratory volume in 1 second for the year was 11.6% less t han that of the non-Medicaid group (p = 0.01); this difference was con stant across age. Medicaid patients averaged 0.8 more admissions for t he year (p < 0.01) and 8.8 more days Cos 0.01) in the hospital but rec eived the same amount of outpatient intravenous therapy. They also had 1.20 more outpatient visits to the center during the year (p = 0.02). Conclusions: Medicaid patients with CF have morse lung function and re quire more treatment for pulmonary exacerbations than their more advan taged counterparts. This difference appears to begin early in life, do es not increase with age, and is not explained by inadequate access to outpatient specialty care or delayed diagnosis. Other explanations su ch as inadequate access to primary care, poor adherence to prescribed regimens, or greater exposure to pollutants (e.g., environmental tobac co smoke) are speculative.