Racial and ethnic differences in asthma diagnosis among children who wheeze
Racial and ethnic differences in asthma diagnosis among children who wheeze
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DOI：
10.1542/peds.2004-0897
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发表时间：
2005-05-01
期刊：
影响因子：
8
通讯作者：
Lara, M
中科院分区：
文献类型：
--
作者：
Akinbami, LJ;Rhodes, JC;Lara, M
背景在报告的儿童哮喘患病率中存在种族和民族差异，但目前尚不清楚差异是否源于真正的患病率差异或从卫生专业人员那里获得诊断的不同可能性。人们担心哮喘可能诊断不足，特别是在少数民族儿童中，他们获得高质量医疗保健的机会更有限。检查目前有症状的儿童在获得哮喘诊断方面的种族/民族差异，以确定少数民族中是否存在相对诊断不足。未报告症状的儿童（包括症状控制良好的儿童）被排除在分析之外。1999年全国健康访谈调查包括一个具有全国代表性的有喘息症状的儿童样本。我们纳入了3 - 17岁的儿童，分析了哮喘诊断的种族/民族差异，控制了年轻、性别、父母教育、单亲家庭、中心城市居住地、居住地区、健康保险、经常护理的地方以及父母报告的喘息性哮喘的严重程度。在过去一年中报告有喘息的儿童中（n = 946），83%的波多黎各儿童、71%的非西班牙裔黑人儿童和65%的墨西哥儿童被诊断为哮喘，而非西班牙裔白色儿童的这一比例为57%。使用非西班牙裔白色儿童作为参照组，在过去一年中，医生诊断哮喘的近似校正相对危险度为1.43（95%置信区间[CI]：1.04，1.63），非西班牙裔黑人为1.22（95% CI：1.03，1.37），墨西哥儿童为1.19（95% CI：0.94，1.39）。据报道，少数民族儿童的喘息症状更严重。即使考虑到这种严重程度的增加，少数种族和少数民族儿童与非西班牙裔白色儿童相比，有相同或更高的哮喘诊断报告。我们的研究结果并没有提供证据来支持有症状的少数民族儿童与非西班牙裔白色儿童相比哮喘诊断不足的假设。相反，在目前有症状的儿童中，少数民族儿童比非西班牙裔白色儿童更容易被诊断，即使考虑到少数民族儿童中喘息的严重程度更高。
Background. Racial and ethnic disparities exist in reported childhood asthma prevalence, but it is unclear if disparities stem from true prevalence differences or a different likelihood of receiving a diagnosis from a health professional. Concern has been raised that asthma may be underdiagnosed, particularly among minority children who have more restricted access to high-quality health care.Objective. To examine racial/ethnic differences among currently symptomatic children in acquiring an asthma diagnosis to determine if relative underdiagnosis among minorities exists. Children for whom no symptoms were reported ( a group that includes those with well-controlled symptoms) were excluded from the analysis.Methods. The 1999 National Health Interview Survey includes a nationally representative sample of children with reported wheezing symptoms. We included children 3 to 17 years old in the study and analyzed racial/ ethnic differences in asthma diagnosis, controlling for young age, gender, parental education, single-parent household, central-city residence, region of residence, health insurance, having a usual place of care, and parent-reported severity of wheezing symptoms.Results. Among those reported to have wheezed in the past year ( n = 946), 83% of Puerto Rican, 71% of non-Hispanic black, and 65% of Mexican children were diagnosed with asthma compared with 57% of non-Hispanic white children. Using non-Hispanic white children as the reference group, the approximate adjusted relative risk for physician diagnosis of asthma given wheezing in the past year was 1.43 (95% confidence interval [CI]: 1.04, 1.63) for Puerto Rican, 1.22 ( 95% CI: 1.03, 1.37) for non-Hispanic black, and 1.19 ( 95% CI: 0.94, 1.39) for Mexican children. Minority children were reported to have greater severity of wheezing symptoms. Even after accounting for this increased severity, children in racial and ethnic minority groups were as or more likely to have a reported asthma diagnosis than non-Hispanic white children.Conclusions. Our findings do not provide evidence for the hypothesis that symptomatic minority children are underdiagnosed with asthma compared with non-Hispanic white children. To the contrary, among currently symptomatic children, minority children were more likely to be diagnosed than non-Hispanic white children even after accounting for the higher wheezing severity among minority children.