Race and sex differences in consistency of care with national asthma guidelines in managed care organizations
Race and sex differences in consistency of care with national asthma guidelines in managed care organizations
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DOI：
10.1001/archinte.161.13.1660
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发表时间：
2001-07-09
影响因子：
--
通讯作者：
Wu, AW
中科院分区：
文献类型：
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作者：
Krishnan, JA;Diette, GB;Wu, AW
背景：在美国，哮喘的发病率对非裔美国人和女性的影响不成比例。研究对象和方法：为了检验种族和性别与哮喘护理的关系，我们分析了1993年9月至12月参与结果管理系统哮喘研究的16个管理型护理组织中登记的成年人对问卷的反应。评估了符合国家哮喘教育和预防计划(1991)建议的护理指标。在随机抽样的8640名患者中，6612人(77%)完成了调查。这项研究集中在5062名至少有中度哮喘症状的患者(非裔美国人14%，女性72%)。结果：非洲裔美国人比白人报告的护理符合以下建议：药物使用(例如，每日吸入皮质类固醇，34.9%比54.4%；P=.001)，自我管理教育(例如，行动计划，42.0%比53.8%；P=.001)，避免触发(37.6%比53.6%；P=.001)，以及专科护理(28.3%比41.0%；P=.001)。在哮喘治疗方面，性别差异较小，除了每天吸入皮质类固醇(女性比男性：49.6%比58.3%；P=.001)和接受专科治疗(37.7%比43.1%；P=.001)外，都倾向于女性。在调整了年龄、教育、就业和症状频率后，观察到了类似的种族和性别差异。结论：即使在有医疗保险的患者中，非裔美国人与白人相比，在哮喘治疗方面也存在差异，这可能是导致种族差异的原因之一。女性普遍报告哮喘护理较好，但可能受益于更多吸入性皮质类固醇的使用。
Background: In the United States, morbidity from asthma disproportionately affects African Americans and women. Although inadequate care contributes to overall asthma morbidity, less is known about differences in asthma care by race and sex.Subjects and Methods: To examine the relationships of race and sex with asthma care, we analyzed responses to questionnaires administered to adults enrolled in 16 managed care organizations participating in the Outcomes Management System Asthma Study between September and December 1993. Indicators of care consistent with National Asthma Education and Prevention Program (1991) recommendations were assessed. Of a random sample of 8640 patients asked to participate, 6612 (77%) completed the survey. This study focused on 5062 (14% African American, 72% women) patients with at least moderate asthma symptom severity.Results: Fewer African Americans than whites reported care consistent with recommendations for medication use (eg, daily inhaled corticosteroid use, 34.9% vs 54.4%; P = .001), self-management education (eg, action plan, 42.0% vs 53.8%; P = .001), avoiding triggers (37.6% vs 53.6%; P = .001), and specialist care (28.3% vs 41.0%; P = .001). Differences in asthma care by sex were smaller and tended to favor women except for daily inhaled corticosteroid use (women vs men: 49.6% vs 58.3%; P = .001) and having specialist care (37.7% vs 43.1%; P = .001). Similar race and sex differences were observed after adjusting for age, education, employment, and symptom frequency.Conclusions: Even among patients with health insurance, disparities in asthma care for African Americans compared with whites exist and may contribute to race disparities in outcomes. Women generally reported better asthma care but may benefit from greater use of inhaled corticosteroids.