Insurance status as a risk factor for foreign body ingestion or aspiration

Objective: To determine whether the lack of private health insurance places children at increased risk for foreign body ingestion or aspiration. Design : Retrospective review. Setting: St. Louis Children's Hospital, a tertiary care center. Patients: Consecutive sample of 125 patients with esophageal or airway foreign bodies. Results: Fifty percent of all patients had private health insurance. Fifty-six percent of all preschool patients and 20% of all school-age patients were uninsured (P < 0.01, Fisher's exact test). Eighty-five percent of patients with airway foreign bodies, and 84% of patients with esophageal foreign bodies were in the preschool group. Sixty-one percent of preschool patients and 21% of school-age patients with esophageal foreign bodies were uninsured (P < 0.05). Forty-six percent of preschool patients with food aspiration lacked health insurance (88% of these children were fed the aspirated item). No school-age group was available for comparison. Fifty percent of preschool children with aspiration of non food items were uninsured, as were 16% of their school-age counterparts. Conclusions: Insurance status must be considered as a risk factor for foreign body aspiration and ingestion. Preschool children are more likely to lack private health insurance than school-age children with the same diagnosis. In a majority of aspiration events, the child was being fed the inappropriate food item, perhaps indicating a lack of caretaker education and anticipatory guidance. A direct focus on 'passive protection', anticipatory guidance in clinics for-all patients, and public education with emphasis on preventive care are proposed as means to decrease the incidence of airway and esophageal foreign bodies in children. (C) 1997 Elsevier Science Ireland Ltd.