Individual and Neighborhood Factors Associated with Undiagnosed Asthma in a Large Cohort of Urban Adolescents
Individual and Neighborhood Factors Associated with Undiagnosed Asthma in a Large Cohort of Urban Adolescents
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DOI：
10.1007/s11524-018-00340-2
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发表时间：
2019-04-01
影响因子：
6.6
通讯作者：
Poghosyan, Lusine
中科院分区：
文献类型：
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作者：
Bruzzese, Jean-Marie;Kingston, Sharon;Poghosyan, Lusine
未确诊的哮喘增加了哮喘的负担，是城市青少年中特别重要的公共卫生问题。虽然对诊断为哮喘的个体水平的人口统计学和社区水平的因素了解很多，但关于这些因素和未诊断的哮喘的数据有限。这项观察性研究评估了一个大的城市青少年队列中未确诊的哮喘与个人和邻里因素之间的关系。我们分析了来自10,295名纽约市青少年的数据，这些青少年报告了哮喘症状和诊断;一个子集（n=6220）提供了我们能够在美国人口普查区域中进行地理编码的地址。多变量回归模型评估未确诊哮喘状态与个体水平变量之间的相关性。分层线性模型评估未确诊哮喘状态与社区水平变量之间的关系。未确诊的哮喘患病率为20.2%。女性未确诊的几率更高（调整后的比值比（AOR）=1.25; 95%置信区间（CI）=1.13-1.37）。与白色、非西班牙裔青少年相比，亚裔美国人有更高的未确诊风险（AOR =1.41; 95% CI =1.01-1.95）;拉丁裔（AOR =0.67; 95% CI =0.45-0.83）;非裔美国人/黑人（AOR =0.66; 95% CI =0.52-0.87）风险较低;拉丁美洲人和非洲裔美国人/黑人没有显著差异。居住在拉丁美洲人相对于非拉丁美洲人的白色人浓度较低的社区与未确诊的风险较低相关（AOR =0.66; CI =0.43-0.95）。居住在卫生保健提供者短缺的社区与未确诊的风险较低相关（AOR =0.80; 95%CI =0.69-0.93）。有必要开展公共卫生运动，教育青少年及其照顾者了解未确诊的哮喘，并教育卫生保健提供者筛查青少年哮喘患者。
Undiagnosed asthma adds to the burden of asthma and is an especially significant public health concern among urban adolescents. While much is known about individual-level demographic and neighborhood-level factors that characterize those with diagnosed asthma, limited data exist regarding these factors and undiagnosed asthma. This observational study evaluated associations between undiagnosed asthma and individual and neighborhood factors among a large cohort of urban adolescents. We analyzed data from 10,295 New York City adolescents who reported on asthma symptoms and diagnosis; a subset (n=6220) provided addresses that we were able to geocode into US Census tracts. Multivariable regression models estimated associations between undiagnosed asthma status and individual-level variables. Hierarchical linear modeling estimated associations between undiagnosed asthma status and neighborhood-level variables. Undiagnosed asthma prevalence was 20.2%. Females had higher odds of being undiagnosed (adjusted odds ratio (AOR) =1.25; 95% confidence interval (CI) =1.13-1.37). Compared to White, non-Hispanic adolescents, Asian-Americans had higher risk of being undiagnosed (AOR =1.41; 95% CI =1.01-1.95); Latinos (AOR =0.67; 95% CI =0.45-0.83); and African-Americans/Blacks (AOR =0.66; 95% CI =0.52-0.87) had lower risk; Latinos and African-Americans/Blacks did not differ significantly. Living in a neighborhood with a lower concentration of Latinos relative to White non-Latinos was associated with lower risk of being undiagnosed (AOR =0.66; CI =0.43-0.95). Living in a neighborhood with health care provider shortages was associated with lower risk of being undiagnosed (AOR =0.80; 95% CI =0.69-0.93). Public health campaigns to educate adolescents and their caregivers about undiagnosed asthma, as well as education for health care providers to screen adolescent patients for asthma, are warranted.