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.