National trends and disparities in healthcare access and coverage among adults with asthma and COPD: 1997 – 2018.

Racial/ethnic and economic disparities in access to care among persons with asthma and COPD have been described, but long-term access trends are unclear.
Has health coverage, and access to care and medications among adults with airway disease improved, and have disparities narrowed?
Using the 1997-2018 National Health Interview Survey, we examined time-trends in health coverage and the affordability of medical care and prescription drugs for adults with asthma and COPD, overall and by income and race/ethnicity. We performed multivariable linear probability regressions comparing coverage and access in 2018 to 1997.
Our sample included 76,843 adults with asthma and 30,548 with COPD. Among adults with asthma, uninsurance rose in the first decade of the twenty-first century, peaking with the Great Recession, but fell after implementation of the Affordable Care Act (ACA). From 1997 to 2018, the uninsurance rate among adults with asthma decreased from 19.4% to 9.6% (adjusted 9.27 percentage points; 95%CI:7.1,11.5). However, the proportions delaying/foregoing medical care due to cost, or going without medications did not improve. Racial/ethnic and economic disparities present in 1997 persisted over the study period. Trends and disparities among those with COPD were similar, although the proportion going without needed medications worsened, rising by an adjusted 7.8 percentage points.
Coverage losses among persons with airway disease in the first decade of the twenty-first century were more than reversed by the ACA, but neither care affordability nor disparities improved Further reform is needed to close these gaps.