Racial/Ethnic Variation in Emergency Department Care for Children With Asthma
Racial/Ethnic Variation in Emergency Department Care for Children With Asthma
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DOI：
10.1097/pec.0000000000001282
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发表时间：
2019-03-01
影响因子：
1.4
通讯作者：
Kharbanda, Anupam B.
中科院分区：
文献类型：
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作者：
Zook, Heather G.;Payne, Nathaniel R.;Kharbanda, Anupam B.
目的评估急诊科（艾德）治疗儿童哮喘patients.Methods的种族/民族群体之间的差异，本研究是一项横断面分析2011年6月至2012年5月间上中西部6个急诊科就诊的儿童（2-18岁）哮喘患者。我们使用混合效应逻辑回归来评估接受类固醇、放射学检查和在30天内返回艾德的几率。我们对在艾德接受过至少一次沙丁胺醇治疗的哮喘患者进行了亚组分析。结果样本包括1755名从ED出院回家的患者的2909次哮喘就诊。在调整人口统计学、保险类型和分诊评分后，（调整后的比值比[aOR]，1.78; 95%置信区间[CI]，1.40-2.26）和西班牙裔（aOR，1.64; 95% CI，1.22-2.22）患者接受类固醇的几率高于白人。与白人相比，非裔美国人（aOR，0.58; 95%CI，0.46-0.74）的放射学检查几率也较低。亚洲人30天艾德再访的几率最低（aOR，0.26; 95% CI，0.08-0.84），未检测到人种/种族组之间的其他显著差异。接受沙丁胺醇治疗的哮喘患者的亚组分析显示了相似的结果，美国印第安人放射学检查的几率也较低（aOR，0.47; 95%CI，0.22-1.01）。结论在这项研究中，与白色儿童相比，来自种族/少数民族的儿童类固醇给药的几率较高，放射学检查的几率较低。这些差异的根本原因可能是多因素的，包括不同程度的疾病严重程度，健康素养和获得护理。
Objective To assess the variation between racial/ethnic groups in emergency department (ED) treatment of asthma for pediatric patients.Methods This study was a cross-sectional analysis of pediatric (2-18 years) asthma visits among 6 EDs in the Upper Midwest between June 2011 and May 2012. We used mixed-effects logistic regression to assess the odds of receiving steroids, radiology tests, and returning to the ED within 30 days. We conducted a subanalysis of asthma visits where patients received at least 1 albuterol treatment in the ED.Results The sample included 2909 asthma visits by 1755 patients who were discharged home from the ED. After adjusting for demographics, insurance type, and triage score, African American (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 1.40-2.26) and Hispanic (aOR, 1.64; 95% CI, 1.22-2.22) patients had higher odds of receiving steroids compared with whites. African Americans (aOR, 0.58; 95% CI, 0.46-0.74) also had lower odds of radiological testing compared with whites. Asians had the lowest odds of 30-day ED revisits (aOR, 0.26; 95% CI, 0.08-0.84), with no other significant differences detected between racial/ethnic groups. Subgroup analyses of asthma patients who received albuterol revealed similar results, with American Indians showing lower odds of radiological testing as well (aOR, 0.47; 95% CI, 0.22-1.01).Conclusions In this study, children from racial/ethnic minority groups had higher odds of steroid administration and lower odds of radiological testing compared with white children. The underlying reasons for these differences are likely multifactorial, including varying levels of disease severity, health literacy, and access to care.