Disparities in the use of urgent health care services among asthmatic children
Disparities in the use of urgent health care services among asthmatic children
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DOI：
10.1016/s1081-1206(10)60021-x
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发表时间：
2006-08-01
影响因子：
5.9
通讯作者：
Claudio, Luz
中科院分区：
文献类型：
--
作者：
Stingone, Jeanette A.;Claudio, Luz
背景：紧急护理占哮喘相关总费用的三分之一。非裔美国人和拉丁裔背景的哮喘儿童比白人儿童使用急诊室 (ED) 和住院的比例更高，尤其是在城市环境中。目的：评估社会经济因素、疾病相关因素和获得护理的因素在利用急诊室和住院服务紧急治疗哮喘方面的作用。方法：在纽约市为不同社会经济背景的儿童提供服务的公立小学中系统地分发了一份家长反应问卷。结果：发现目前 5 至 12 岁儿童的哮喘患病率为 13.0%。目前近一半的哮喘患者在过去 12 个月内曾在急诊室或医院接受过紧急护理。在单变量分析中，紧急护理的使用与种族/民族和收入密切相关（P < .001）。调整社会经济、疾病相关和获得护理的因素，包括家庭收入、症状严重程度、健康保险类型和哮喘护理的常用来源，种族/族裔差异仍然存在，拉丁裔使用紧急护理的风险是白人的 5 倍，非裔美国人使用紧急护理的风险是白人的两倍。结论：这一城市人口的哮喘管理存在失败，这一发现表明目前几乎一半的哮喘患者都使用紧急护理。在控制了不同的社会经济和疾病相关因素后，发现少数族裔/民族、家庭收入低和频繁的夜间症状是紧急护理利用的强有力的预测因素。研究发现，保险状况、因任何原因延迟护理以及使用控制药物与紧急护理的使用无关。
Background: Urgent care composes one third of the total costs associated with asthma. Asthmatic children of African American and Latino backgrounds have higher rates of emergency department (ED) use and hospitalizations than white children, especially in urban settings. Objective: To evaluate the role of socioeconomic, disease-related, and access-to-care factors in utilization of the ED and inpatient services for urgent treatment of asthma.Methods: A parent-response questionnaire was systematically distributed in public elementary schools that serve children of different socioeconomic backgrounds in New York City.Results: The prevalence of current asthma was found to be 13.0% in 5- to 12-year-old children. Almost half of the current asthmatic patients had used urgent care in the ED or hospital in the previous 12 months. In univariate analysis, use of urgent care was strongly associated with race/ethnicity and income (P < .001). Adjusting for socioeconomic, disease-related, and access-to-care factors, including household income, symptom severity, type of health insurance, and usual source of asthma care, the racial/ethnic disparity persisted, with Latinos having 5 times the risk and African Americans having double the risk of using urgent care as whites.Conclusions: There is a failure in asthma management in this urban population, demonstrated by the finding that almost half of all current asthmatic patients used urgent care. After controlling for different socioeconomic and disease-related factors, minority race/ethnicity, low household income, and frequent evening symptoms were found to be strong predictors of urgent care utilization. Insurance status, delaying care for any reason, and use of controller medications were found not to be associated with urgent care use.