Ethnic Differences in Severe Asthma Clinical Care and Outcomes: An Analysis of United Kingdom Primary and Specialist Care
Ethnic Differences in Severe Asthma Clinical Care and Outcomes: An Analysis of United Kingdom Primary and Specialist Care
复制标题
DOI：
10.1016/j.jaip.2021.09.034
复制
发表时间：
2022-02-07
影响因子：
9.4
通讯作者：
Pfeffer, Paul E.
中科院分区：
文献类型：
--
作者：
Busby, John;Heaney, Liam G.;Pfeffer, Paul E.
背景：了解种族对重症哮喘的影响对于优化个性化患者护理非常重要。目的：评估英国严重哮喘患者在疾病控制、恶化、生物表型和治疗方面的种族差异。方法：我们比较了英国严重哮喘登记处（UKSAR）和最佳患者护理研究数据库（OPCRD）中白人和代表性不足的少数民族患者的人口统计学、2型生物标志物、肺功能、哮喘控制、药物和医疗保健使用情况。结果：UKSAR共纳入3637例患者（665例来自代表性不足的族裔），OPCRD共纳入10549例患者（577例来自代表性不足的族裔）。当使用UKSAR哮喘控制问卷（优势比[OR] = 1.47； 95%可信区间[CI]， 1.12-1.93）和OPCRD中的皇家医师学院3个问题（OR = 1.82; 95% CI, 1.27-2.60）进行测量时，代表性不足的少数民族患者的疾病未控制水平较高。虽然急性发作率相似，但代表性不足的少数民族患者更有可能最近因哮喘而进过急诊室（OR = 1.55; 95% CI, 1.26-1.92）或住院（OR = 1.31; 95% CI, 1.07-1.59）。炎症生物标志物在代表性不足的族裔群体中始终较高，包括OPCRD的血嗜酸性粒细胞（比值= 1.12,95% CI, 1.05-1.20）和UKSAR的血嗜酸性粒细胞（比值= 1.16,95% CI, 1.06-1.27）、FeNO（比值= 1.14,95% CI, 1.04-1.26）和IgE（比值= 1.70,95% CI, 1.47-1.97）。未被充分代表的少数民族患者更有可能在UKSAR （OR = 1.32; 95% CI, 1.07-1.63）和OPCRD （OR = 1.67; 95% CI, 1.26-2.21）中出现特应性反应，并且在转诊时较少使用维持性口服皮质类固醇（OR = 0.75; 95% CI, 0.61-0.92）。结论：来自代表性不足的少数民族的严重哮喘患者呈现出更高的疾病负担，并且更有可能进入急诊室。他们有不同的表型表现和用药差异，2型生物标志物水平较高。(c) 2021美国过敏、哮喘与免疫学学会（J Allergy clinimmunol practice 2022;10:495-505）
BACKGROUND: Understanding the effects of ethnicity in severe asthma is important for optimal personalized patient care.OBJECTIVE: To assess ethnic differences in disease control, exacerbations, biological phenotype, and treatment in severe asthma in the United Kingdom. METHODS: We compared demographics, type 2 biomarkers, lung function, asthma control, medications, and health care use between White and underrepresented ethnic group patients in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD). RESULTS: A total of 3637 patients (665 from the underrepresented ethnic group) were included from UKSAR and 10,549 (577 from the underrepresented ethnic group) from OPCRD. Patients in the underrepresented ethnic group had higher levels of uncontrolled disease when measurements were made using the asthma control questionnaire in UKSAR (odds ratio [OR] = 1.47; 95% confidence interval [CI], 1.12-1.93) and the Royal College of Physicians 3 Questions in OPCRD (OR = 1.82; 95% CI, 1.27-2.60). Although exacerbation rates were similar, patients in the underrepresented ethnic group were more likely to have recently attended the emergency department (OR = 1.55; 95% CI, 1.26-1.92) or to have been hospitalized (OR = 1.31; 95% CI, 1.07-1.59) owing to asthma. Inflammatory biomarkers were consistently higher in the underrepresented ethnic group, including blood eosinophils in OPCRD (ratio = 1.12; 95% CI, 1.05-1.20) and in UKSAR blood eosinophils (ratio = 1.16; 95% CI, 1.06-1.27), FeNO (ratio = 1.14; 95% CI, 1.04-1.26), and IgE (ratio = 1.70; 95% CI, 1.47-1.97). Patients in the underrepresented ethnic group were more likely to be atopic in the UKSAR (OR = 1.32; 95% CI, 1.07-1.63) and OPCRD (OR = 1.67; 95% CI, 1.26-2.21), and less likely to be using maintenance oral corticosteroids at referral (OR = 0.75; 95% CI, 0.61-0.92). CONCLUSIONS: Severe asthma patients from underrepresented ethnic groups presented with a higher disease burden and were more likely to attend the emergency department. They had a distinct phenotypic presentation and differences in medicine use, with higher levels of type 2 biomarkers.(c) 2021 American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2022;10:495-505)