Individual and county level predictors of asthma related emergency department visits among children on Medicaid: A multilevel approach.
Individual and county level predictors of asthma related emergency department visits among children on Medicaid: A multilevel approach.
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DOI：
10.1080/02770903.2016.1196367
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发表时间：
2017-01-02
期刊：
影响因子：
--
通讯作者：
Rust G
中科院分区：
文献类型：
--
作者：
Baltrus P;Xu J;Immergluck L;Gaglioti A;Adesokan A;Rust G
在美国，哮喘结果的差异有据可查。促进哮喘结果公平的干预措施可以针对个人和社区层面的因素。本分析的目的是了解个人（种族、性别、年龄和预防性吸入器的使用）和县级因素（人口、社会经济、医疗保健、空气质量）对参加医疗补助的儿童哮喘急诊科 (ED) 就诊的影响。这是一项针对 2009 年 29 个州参加医疗补助的哮喘儿童的回顾性队列研究。利用医疗补助登记文件中的个人层面变量（种族、性别、年龄和预防性吸入器的使用）以及地区资源文件 (ARF) 中反映人口和卫生系统特征的县级变量，构建了哮喘急诊就诊的多级回归模型。县级空气质量测量数据来自环境保护局 (EPA) 数据。研究发现，个体层面的主要可改变危险因素是长期控制药物与哮喘总药物的比率。县级因素约占哮喘急诊就诊风险差异的 6%。县级种族隔离的加剧（OR=1.04，95% CI=1.01-1.08）与哮喘急诊就诊风险增加相关。县级肺科医生供应量增加（OR=0.81，95% CI=0.68-0.97）与哮喘急诊就诊风险降低相关。在患者护理层面，正确使用控制药物是最容易干预的因素。社会还迫切需要解决消极的社会决定因素，例如居住隔离。
Disparities in asthma outcomes are well documented in the United States. Interventions to promote equity in asthma outcomes could target factors at the individual and community levels. The objective of this analysis was to understand the effect of individual (race, gender, age, and preventive inhaler use) and county-level factors (demographic, socioeconomic, health care, air-quality) on asthma emergency department (ED) visits among Medicaid-enrolled children. This was a retrospective cohort study of Medicaid-enrolled children with asthma in 29 states in 2009. Multilevel regression models of asthma ED visits were constructed utilizing individual-level variables (race, gender, age, and preventive inhaler use) from the Medicaid enrollment file and county-level variables reflecting population and health system characteristics from the Area Resource File (ARF). County-level measures of air quality were obtained from Environmental Protection Agency (EPA) data. The primary modifiable risk factor at the individual level was found to be the ratio of long-term controller medications to total asthma medications. County-level factors accounted for roughly 6% of the variance in the asthma ED visit risk. Increasing county-level racial segregation (OR=1.04, 95% CI=1.01-1.08) was associated with increasing risk of asthma ED visits. Greater supply of pulmonary physicians at the county level (OR=0.81, 95% CI=0.68-0.97) was associated with a reduction in risk of asthma ED visits. At the patient care level, proper use of controller medications is the factor most amenable to intervention. There is also a societal imperative to address negative social determinants, such as residential segregation.
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影响因子：
3.5
作者：
MASSEY, DS;DENTON, NA
通讯作者：
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8
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3.4
作者：
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