Influences of Socioeconomic Status on Costs of Asthma Under Universal Health Coverage
Bibliographic record
Abstract
BACKGROUND: Despite Canada's provision of universal health coverage, socioeconomic barriers to good-quality health care remain. Asthma provides an appropriate case study given its high prevalence, availability of effective controller therapies, and known variations in care. OBJECTIVES: The aim of this study is to examine the extent of differences in the economic burden of asthma and indicators of guideline-based care across socioeconomic status (SES) gradients. RESEARCH DESIGN: A total of 29,283 adults with moderate to severe asthma were identified from British Columbia's administrative health data for the year 1997-2013 and were matched to adults without asthma on the basis of sex and age. Direct medical costs (in 2013 Canadian dollars, $) included all-cause inpatient, outpatient, and pharmacy costs. SES was measured at individual (receiving social assistance) and aggregate (median neighborhood household income) levels. We assessed the impact of SES on excess direct costs of asthma (the difference in all-cause direct medical costs between an asthma patient and the matched individual), and on use of asthma controller versus reliever medications. Associations were evaluated using generalized linear models. RESULTS: Asthmatics receiving social assistance incurred $706 (95% confidence interval, $302-$1014) higher annual excess costs than the rest of the sample. Annual excess costs were $120 ($18-$168) higher in low-SES versus high-SES neighborhoods. Low SES, at both individual and aggregate levels, was consistently associated with lower expenses on controller medications and higher expenses on reliever medications, indicators of suboptimal asthma care and control. CONCLUSION: Even under universal health care, individuals in lower SES groups did not receive guideline-based asthma care, potentially explaining their higher costs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".