Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program
Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program
复制标题
DOI：
10.1016/j.jaci.2018.11.022
复制
发表时间：
2019-06-01
影响因子：
14.2
通讯作者：
Teague, W. Gerald
中科院分区：
文献类型：
--
作者：
Fitzpatrick, Anne M.;Gillespie, Scott E.;Teague, W. Gerald
背景：尽管哮喘治疗取得了进展，但差距仍然存在。黑人患者的哮喘和preventionally影响也有较差的结果相比，白色patients.Objective：我们试图确定黑人和白色患者和哮喘相关的医疗保健使用之间的关联，占复杂的relationships.Methods：这项研究是作为国家心脏，肺和血液研究所的严重哮喘研究计划，前瞻性观察队列的一部分完成。在2012年11月至2015年2月期间，它招募了579名6岁及以上的参与者，观察时间为1年，数据完整。使用治疗权重的逆概率来平衡种族群体在社区和家庭社会经济变量以及环境暴露变量方面的平衡。主要结局是急诊科（艾德）用于哮喘。次要结果包括吸入性皮质类固醇的使用，门诊医生的办公室访问哮喘，哮喘相关的hospitalis.Results：黑人患者有更大的几率艾德使用超过1年（比值比，2.19; 95%CI，1.43-3.35），但也不同的大多数（>50%）的基线变量测量。在种族组的统计平衡后，黑人和白人患者在艾德使用方面的差异不再达到显著性水平。相反，在二次分析中，黑人患者不太可能去看门诊医生进行哮喘管理（调整后的比值比，0.57; 95%CI，0.38-0.85）。结论：在考虑多个变量后，消除了艾德使用的差异。针对哮喘负担高的黑人群体的社会和环境政策和干预措施对减少（或消除）这些差异至关重要。
Background: Despite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared with white patients.Objective: We sought to determine associations between black and white patients and asthma-related health care use, accounting for complex relationships.Methods: This study was completed as part of the National Heart, Lung, and Blood Institute's Severe Asthma Research Program, a prospective observational cohort. Between November 2012 and February 2015, it enrolled 579 participants 6 years and older with 1 year of observation time and complete data. Inverse probability of treatment weighting was used to balance racial groups with respect to community and family socioeconomic variables and environmental exposure variables. The primary outcome was emergency department (ED) use for asthma. Secondary outcomes included inhaled corticosteroid use, outpatient physician's office visits for asthma, and asthma-related hospitalization.Results: Black patients had greater odds of ED use over 1 year (odds ratio, 2.19; 95% CI, 1.43-3.35) but also differed in the majority (>50%) of baseline variables measured. After statistical balancing of the racial groups, the difference between black andwhite patients with respect to ED use no longer reached the level of significance. Instead, in secondary analyses black patients were less likely to see an outpatient physician for asthma management (adjusted odds ratio, 0.57; 95% CI, 0.38-0.85).Conclusions: The disparity in ED use was eliminated after consideration of multiple variables. Social and environmental policies and interventions tailored to black populations with a high burden of asthma are critical to reduction (or elimination) of these disparities.