Differences in Prevalence, Treatment, and Outcomes of Asthma Among a Diverse Population of Children With Equal Access to Care Findings From a Study in the Military Health System
Differences in Prevalence, Treatment, and Outcomes of Asthma Among a Diverse Population of Children With Equal Access to Care Findings From a Study in the Military Health System
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DOI：
10.1001/archpediatrics.2010.100
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发表时间：
2010-08-01
影响因子：
--
通讯作者：
Croghan, Thomas W.
中科院分区：
文献类型：
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作者：
Stewart, Kate A.;Higgins, Patricia C.;Croghan, Thomas W.
目的：评估不同种族和民族在哮喘患病率、治疗模式和结果方面的差异，这些差异在不同的儿童人群中具有平等的卫生保健机会。设计：回顾性队列分析。设置：军队卫生系统。参与者：2007年，共有822 900名2至17岁的儿童连续参加了TRICARE Prime，由国防部提供的健康维护组织类型的福利。主要结果测量：2至4岁儿童中确诊哮喘的患病率、可能避免的哮喘住院、哮喘相关急诊就诊、哮喘专家就诊和哮喘药物使用，结果：所有年龄组的黑人和西班牙裔儿童比白色儿童更容易诊断为哮喘（范围从比值比[OR]= 1.16; 95%可信区间[CI]，1.09-1.24;到OR=2.00; 95%CI，1.93-2.07）。所有年龄组的黑人儿童和5至10岁的西班牙裔儿童明显更有可能发生任何可能避免的哮喘住院和哮喘相关急诊（OR=1.24; 95% CI，1.11-1.37; OR=1.99; 95% CI，1.37-2.88），并且不太可能去看专家（范围从OR=0.71; 95% CI，0.61-0.82;到OR=0.88; 95% CI，0.79-0.98）与白色儿童相比。与白色儿童相比，所有年龄段的黑人儿童更有可能使用吸入性皮质类固醇（范围从OR=1.11; 95%CI，1.02-1.21;到OR=1.11; 95%CI，1.04-1.19）。尽管全民健康保险覆盖，我们发现了哮喘患病率，治疗和结果的种族和民族差异的证据。
Objective: To assess racial and ethnic differences in asthma prevalence, treatment patterns, and outcomes among a diverse population of children with equal access to health care.Design: Retrospective cohort analysis.Setting: The Military Health System.Participants: A total of 822 900 children aged 2 through 17 years continuously enrolled throughout 2007 in TRICARE Prime, a health maintenance organization-type benefit provided by the Department of Defense.Main Outcome Measures: Prevalence of diagnosed asthma, potentially avoidable asthma hospitalizations, asthma-related emergency department visits, visits to asthma specialists, and use of asthma medications among children aged 2 to 4, 5 to 10, and 11 to 17 years.Results: Black and Hispanic children in all age groups were significantly more likely to have an asthma diagnosis than white children (ranging from odds ratio [OR]= 1.16; 95% confidence interval [CI], 1.09-1.24; to OR=2.00; 95% CI, 1.93-2.07). Black children in all age groups and Hispanic children aged 5 to 10 years were significantly more likely to have any potentially avoidable asthma hospitalizations and asthma-related emergency department visits (ranging from OR=1.24; 95% CI, 1.11-1.37; to OR=1.99; 95% CI, 1.37-2.88) and were significantly less likely to visit a specialist (ranging from OR=0.71; 95% CI, 0.61-0.82; to OR=0.88; 95% CI, 0.79-0.98) compared with white children. Black children in all age categories were significantly more likely to have filled any prescriptions for inhaled corticosteroids compared with white children (ranging from OR=1.11; 95% CI, 1.02-1.21; to OR=1.11; 95% CI, 1.04-1.19).Conclusions: Despite universal health insurance coverage, we found evidence of racial and ethnic differences in asthma prevalence, treatment, and outcomes.