Understanding racial disparities in childhood asthma using individual- and neighborhood-level risk factors.
Understanding racial disparities in childhood asthma using individual- and neighborhood-level risk factors.
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DOI：
10.1016/j.jaci.2022.07.024
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发表时间：
2022-12
影响因子：
14.2
通讯作者：
Mersha, Tesfaye B.
中科院分区：
文献类型：
--
作者：
Correa-Agudelo, Esteban;Ding, Lili;Beck, Andrew F.;Brokamp, Cole;Altaye, Mekibib;Kahn, Robert S.;Mersha, Tesfaye B.
关键词：
儿童哮喘预后的种族差异是由个体和社区水平因素的复杂相互作用造成的。研究非洲裔美国人（AA）和欧洲裔美国人（EA）儿童哮喘相关急诊（艾德）就诊的种族差异。这是一项对2009-2018年因哮喘在辛辛那提儿童医院艾德就诊的<18岁患者的回顾性研究。结果是一年内艾德就诊的次数。我们评估了11个社会、经济和环境变量。中介和混合效应分析用于评估种族、中介和艾德就诊次数之间的关系。共有31，114名儿童（46.1% AA，53.9% EA）接受了186，779次哮喘相关艾德访视。AA儿童每年的就诊次数多于EA儿童（2.23 vs 2.15; p<0.001）。与商业保险相比，医疗补助保险与艾德就诊增加7%相关（1.07; 95%置信区间[CI]=1.03-1.1）。邻里社会经济剥夺与AA的艾德就诊率增加相关，而与EA儿童无关。对于AA和EA儿童，区域水平的PM2.5、花粉和户外霉菌与艾德就诊率增加相关（所有p<0.001）。种族和艾德就诊次数之间的关联由保险（标准化系数[sβ]=0.048; p<0.001）、区域水平的剥夺（sβ=0.084; p<0.001）、PM2.5（sβ=0.002; p<0.001）和户外霉菌（sβ=0.006; p<0.001）介导，共占种族对艾德就诊影响的55%。在考虑介质后，种族与艾德访视次数无关（sβ=0.006; p=0.796）。哮喘相关艾德就诊中的种族差异受社会、经济和环境因素的影响，这些因素可能适用于旨在改善结局和消除不平等的干预措施。我们使用中介和混合效应分析确定了一系列个人和社区水平因素对哮喘相关艾德就诊种族差异的影响。
Racial disparities in childhood asthma outcomes result from a complex interplay of individual- and neighborhood-level factors. To examine racial disparities in asthma-related emergency department (ED) visits between African American (AA) and European American (EA) children. This is a retrospective study of patients <18 years who visited the ED at Cincinnati Children’s for asthma, 2009–2018. The outcome was number of ED visits during a year. We assessed 11 social, economic, and environmental variables. Mediation and mixed-effects analyses were used to assess relationships between race, mediators, and number of ED visits. A total of 31,114 children (46.1% AA, 53.9% EA) had 186,779 asthma-related ED visits. AA children had more visits per year than EA children (2.23 vs 2.15; p<0.001). Medicaid insurance was associated with a 7% increase in ED visits compared with commercial insurance (1.07; 95% Confidence interval [CI]=1.03–1.1). Neighborhood socioeconomic deprivation was associated with an increased rate of ED visits in AA, not EA children. Area-level PM2.5, pollen, and outdoor mold were associated with an increased rate of ED visits for both AA and EA children (all p<0.001). Associations between race and number of ED visits were mediated by insurance (standardized coefficient [sβ]=0.048; p<0.001) and area-level deprivation (sβ=0.084; p<0.001), PM2.5 (sβ=0.002; p<0.001), and outdoor mold (sβ=0.006; p<0.001), altogether accounting for 55% of race’s effect on ED visits. Race was not associated with number of ED visits (sβ=0.006; p=0.796) after accounting for mediators. Racial disparities in asthma-related ED visits are mediated by social, economic, and environmental factors which may be amenable to interventions aimed at improving outcomes and eliminating inequities. We determine the effect of a range of individual- and neighborhood-level factors on racial disparities for asthma-related ED visits using mediation and mixed-effects analyses.
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期刊：
The Journal of allergy and clinical immunology
影响因子：
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