BD-10 The distribution of insurance in a population-based cohort of SLE: georgians organized against lupus cohort

Abstract

Background Having health insurance coverage is important for people with chronic conditions. Those with systemic lupus erythematosus (SLE) are particularly vulnerable given the disproportionate impact on young minorities and women. This is the first description of health insurance changes over time overall and by sociodemographic groups on a population level. Methods The Georgians Organized Against Lupus (GOAL) is a cohort of validated patients with SLE living in Atlanta, predominantly derived from the population-based and Centers for Disease Control and Prevention (CDC) funded Georgia Lupus Registry. Participants have been surveyed annually, including sociodemographics, health insurance, disease activity (Systemic Lupus Activity Questionnaire), and damage (Self-Administered Brief Index of Lupus Damage). Self-reported health insurance was categorized into no insurance, private, Medicare, Medicaid, and Medicare/Medicaid. Those reported being in a different category the year before were classified as having changed insurance. Results An average of 642 individuals were surveyed annually from 2012 to 2016. At baseline, the average age was 46.4±13.4 and disease duration was 13.6±9.2 years. 93.6% were female and 78.5% black. 35.1% had a high school educational level or less, 45.8% were at or below the Federal poverty level, 34.6% were married or with a partner, and 35% were employed. Figure 1 shows the distribution of insurance categories from 2012 through 2016. Compared to the year before, 23.8% changed insurance in 2013, 22.2% in 2014, 24.1% in 2015, and 26.8% in 2016. Those who changed insurance tended to be black, lower in educational attainment, poorer, unemployed, and have greater disease activity and damage. Conclusions In a population-based cohort in Georgia, the majority with SLE have private insurance and Medicare, which has grown over time while those uninsured have dropped. This is in line, but greater in magnitude, with the decrease in uninsured seen with the Affordable Care Act. Georgia is one of the states that has not expanded Medicaid resulting in flat enrollment. There also appears to be an increase in those who switch insurance categories. In this era of fluctuating health care policy, it is important to learn how types of and changes in coverage affect health care utilization, disease treatment and outcomes, self-reported health, and mortality in SLE, particularly given the disproportionate impact on vulnerable groups. Studies utilizing administrative data should also be aware of medical coverage distributions and regional variations in policy that impact these distributions. Acknowledgements Supported by 3U58DP001487–05 W2 and U01DP005119 (CDC).