A longitudinal study of adult-onset asthma incidence among HMO members.
A longitudinal study of adult-onset asthma incidence among HMO members.
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HMO成员中成人发病率的纵向研究。
DOI：
10.1186/1476-069x-2-10
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发表时间：
2003-08-07
影响因子：
6
通讯作者：
Milton, Donald K
中科院分区：
文献类型：
--
作者：
Sama, Susan R;Hunt, Phillip R;Cirillo, C I H Priscilla;Marx, Arminda;Rosiello, Richard A;Henneberger, Paul K;Milton, Donald K
HMO数据库为哮喘发病率、病因和治疗的社区流行病学研究提供了机会。HMO人群中哮喘的发病率和HMO数据的使用，包括使用计算机算法和手动审查病历以确定病因，尚未得到充分探索。我们在新英格兰的一家医疗保健组织中使用计算机记录搜索，确定了成人哮喘。每月，我们的软件应用排除和纳入标准来识别“高危”人群和“潜在病例”。然后对每个潜在病例的过去一年的电子和纸质医疗记录进行审查。排除了患有其他呼吸系统疾病或哮喘治疗意义不大的人。确诊的成人哮喘(AOA)病例被定义为新发哮喘或重新发作的轻度间歇性哮喘至少一年的潜在病例。我们通过回顾被算法拒绝的被选对象的图表来验证方法。该算法的灵敏度为93%~99.3%，特异度为99.6%。63%(n=469)的潜在病例被确认为AOA。三分之二的确诊病例是平均年龄为34.8岁的女性(SD11.8)，45%的人没有哮喘诊断的证据。每1000名高危成员的年化AOA月率从4.1到11.4不等。医生最常将哮喘归因于感染(59%)和过敏(14%)。新发病例更有可能归因于感染，而重新激活的病例更可能与过敏有关。病历中只有32例(7%)的病例讨论了工作暴露与哮喘的关系。其中23人(72%)表示哮喘与工作场所暴露之间存在关联，导致与工作相关的哮喘的总体发生率为4.9%。计算机化的HMO记录可以成功地用于识别AOA。手动复查这些记录对于确认病例状态很重要，并且有助于评估提供者对病因的考虑。我们证明，临床医生将大多数AOA归因于感染，并倾向于忽视环境和职业暴露的贡献。
HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored. We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA) cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm. The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469) of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8), and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59%) and allergy (14%). New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7%) cases. Twenty-three of these (72%) indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%. Computerized HMO records can be successfully used to identify AOA. Manual review of these records is important to confirm case status and is useful in evaluation of provider consideration of etiologies. We demonstrated that clinicians attribute most AOA to infection and tend to ignore the contribution of environmental and occupational exposures.