Role of Financial and Social Hardships in Asthma Racial Disparities
Role of Financial and Social Hardships in Asthma Racial Disparities
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DOI：
10.1542/peds.2013-2437
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发表时间：
2014-03-01
期刊：
影响因子：
8
通讯作者：
Kahn, Robert S.
中科院分区：
文献类型：
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作者：
Beck, Andrew F.;Huang, Bin;Kahn, Robert S.
背景和结论：卫生保健改革为解决儿童健康差距提供了新的机会。本研究旨在描述儿童哮喘再入院的种族差异，重点关注未来患者护理模型中可能解决的困难的潜在解释作用：我们招募了774名儿童，年龄1至16岁，在一个以人群为基础的前瞻性观察队列中因哮喘或支气管哮喘反应性喘息入院。结果是再次入院的时间。记录了儿童种族、社会经济地位（以较低收入和照顾者教育程度衡量）和困难（照顾者找工作、没有人借钱、没有汽车或房子、单身/未婚）。分析采用考克斯比例hazards.Results：队列是57%的非洲裔美国人，33%的白色，和10%的多种族/其他; 19%在12个月内重新入院。调整哮喘严重程度分类后，非裔美国人再次入院的可能性是白人的两倍（风险比：1.98; 95%置信区间：1.42 - 2.77）。与白人相比，非洲裔美国人照顾者更有可能报告收入和教育程度较低，难以找到工作，没有人借钱，没有汽车或房子，单身/未婚（所有P 40%）。其他因素（如污染、烟草暴露、住房质量）也可以解释剩余差距。有针对性的干预措施可以帮助实现更大的儿童健康公平。
BACKGROUND AND OBJECTIVES: Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models.METHODS: We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded. Analyses used Cox proportional hazards.RESULTS: The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being single/never married (all P 40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity.