High asthma prevalence and increased morbidity among rural children in a Medicaid cohort.
High asthma prevalence and increased morbidity among rural children in a Medicaid cohort.
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DOI：
10.1016/j.anai.2011.02.013
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发表时间：
2011-06
期刊：
影响因子：
--
通讯作者：
Hartert TV
中科院分区：
文献类型：
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作者：
Valet RS;Gebretsadik T;Carroll KN;Wu P;Dupont WD;Mitchel EF;Hartert TV
城市儿童是哮喘发展和不良哮喘结局的高危人群。尽管农村儿童也会遇到社会人口差异，这可能会加剧哮喘，但美国农村对哮喘的研究很少。目的：了解城乡儿童哮喘诊断和发病率的差异。我们研究了全州范围内117,080名儿童，从出生到六岁一直参加田纳西州医疗补助计划，使用链接的田纳西州医疗补助计划、生命记录和药房索赔数据库来确定哮喘的诊断和居住情况。队列中45%的人是城市人，23%是郊区人，33%是农村人。与城市儿童相比，农村儿童更有可能是白人，有毛细支气管炎病史，母亲吸烟。11%的城市儿童、12%的郊区儿童和13%的农村儿童符合哮喘诊断的研究标准(调整后的优势比[OR]为1.16，95%可信区间[CI]1.09~1.24；郊区儿童调整后的OR为1.22，95%的可信区间为1.14~1.30，以城市为参照物，P<；0.001)。农村儿童更多地利用门诊哮喘护理，而城市儿童更多地利用吸入性皮质类固醇。与城市儿童相比，农村儿童哮喘急诊就诊次数较少，但因哮喘住院的比率相似。哮喘控制的其他标志，包括口服皮质类固醇和短效β-激动剂的使用，在农村和城市儿童中相似。在这一儿科医疗补助人群中，与城市儿童相比，农村儿童的哮喘患病率增加，哮喘发病率相似，哮喘护理和资源利用的模式不同。
Urban children represent a group at high risk for asthma development and adverse asthma outcomes. Although rural children also encounter sociodemographic disparities that might be expected to worsen asthma, asthma in the rural US is poorly studied. To determine rural-urban differences in childhood asthma diagnosis and morbidity. We studied a statewide population of 117,080 children continuously enrolled in Tennessee Medicaid from birth through the sixth year of life, using linked Tennessee Medicaid, vital records, and pharmacy claims databases to determine asthma diagnosis and residence. The cohort was 45% urban, 23% suburban, and 33% rural. Compared with urban children, rural children were more likely to be white, have a history of bronchiolitis, and have mothers who smoked. Eleven percent of urban, 12% of suburban, and 13% of rural children met study criteria for asthma diagnosis (adjusted odds ratio [OR] for rural children 1.16, 95% confidence interval [CI] 1.09–1.24, and for suburban children adjusted OR 1.22, 95% CI 1.14–1.30, with urban as referent, P<0.001). Rural children had greater utilization of outpatient asthma care, whereas urban children had greater utilization of inhaled corticosteroids. Compared with urban children, rural children had fewer asthma ED visits, but were hospitalized for asthma at similar rates. Others markers of asthma control, including oral corticosteroid and short acting beta agonist usage, were similar between rural and urban children. In this pediatric Medicaid population, rural children had increased asthma prevalence, similar asthma morbidity, and differences in patterns of asthma care and resource utilization compared with urban children.