The Role of Social, Economic and Environmental Factors in Food Allergy Disparities

项目摘要和摘要 背景：食物过敏(FA)是一种潜在威胁生命的慢性疾病，影响约32 百万美国儿童和成人。虽然估计有7.6%的美国儿童患有FA，但非裔美国人 与非西班牙裔白人儿童相比，西班牙裔儿童的风险显著增加。在儿童中 参加医疗补助计划的种族和民族与FA相关，因此亚洲人、黑人和 与白人儿童相比，太平洋岛民/夏威夷原住民儿童有更高的FA奇数。此外, 种族和收入差距在足总的经济负担和 接受以指南为基础的过敏治疗。尽管差异的证据越来越多，但很少有研究表明 审查差异的来源，特别是可修改的因素，如当地食物的特点 环境，而且没有人使用过私人保险儿童的大量管理数据。 具体目标和方法：本研究的主要目的如下：1)测量种族和 美国儿童在FA诊断和管理方面的种族、收入和地理差异，2)到 评估社会、经济和环境因素对差异的贡献，3)确定区域热点 美国食物过敏儿童的FA诊断和治疗结果。这项研究将 利用两个互补的管理数据来检查差异：Medicaid和CHIP T-MSIS 分析文件(TAF)和医疗保健成本研究所(HCCI)商业索赔研究数据集。这个 TAF的研究人群将包括至少49个州和 哥伦比亚特区。HCCI的数据将包括大约11个月雇主赞助的保险索赔 每年有100万名0-17岁的美国儿童。县级特色将从加州大学 威斯康星州人口健康研究所的县健康排名&路线图和美国农业部的食品 环境地图集。经验主义的方法将使用 医学研究所(IOM)2003年的报告，不平等待遇。 假设和预期结果：我们的 关联 商店 解释 主要的研究假设基于概念模型。 危险的食品环境，包括高度粮食不安全的软管和食品杂货供应减少 较差的食物过敏管理。具体地说，我们假设食物环境 FA诊断和处理的差异有统计学意义的百分比。 对其他研究的意义和影响：这将是第一个系统考察差异的研究 在私人和公共保险的儿童中进行FA诊断和管理，并率先利用 现有数据，以探讨食物环境对差异的影响。食物环境代表着一种 潜在的可修改的干预目标，以改善以指南为基础的过敏护理的差异，并减少 无意的过敏反应。

PROJECT SUMMARY AND ABSTRACT Background: Food Allergy (FA) is a potentially life-threatening chronic condition that affects approximately 32 million U.S. children and adults. While an estimated 7.6% of U.S. children have FA, African-American non- Hispanic children have a significantly elevated risk relative to non-Hispanic white children. Among children enrolled in the Medicaid program, race and ethnicity were associated with FA such that Asian, Black, and Pacific Islander/Native Hawaiian children had a higher odd of FA compared with white children. In addition, racial and income disparities have been observed in the economic burden of FA and in the likelihood of receiving guideline-based allergy care. Although evidence of disparities is growing, few studies have examined the source of disparities, especially modifiable factors such as features of the local food environment, and none have used large administrative data from privately insured children. Specific Aims and Methods: Theprimary aims of this study are as follows: 1)To measure racial and ethnic, income, and geographic disparities in FA diagnosis and management among U.S. children, 2) To assess the contribution of social, economic, and environmental factors to disparities, 3) To identify regional hot spots of FA diagnosis and management outcomes among U.S. children with food allergy. This study will leverage two complementary administrative data to examine disparities: the Medicaid and CHIP T-MSIS Analytic File (TAF) and the Health Care Cost Institute (HCCI) Commercial Claims Research Dataset. The study population in the TAF will include all children enrolled in the Medicaid program in at least 49 states and the District of Columbia. The HCCI data will include employer-sponsored insurance claims on approximately 11 million U.S. children ages 0-17 per year. County-level characteristics will be drawn from the University of Wisconsin Population Health Institute's County Health Rankings & Roadmaps and the USDA's Food Environment Atlas. The empirical approach will use the framework of racial and ethnic disparity put forth in the Institute of Medicine's (IOM) 2003 report, Unequal Treatment. Hypotheses and Expected Results: Our associating stores explain primary study hypotheses are based on a conceptual model risky food environments including t hose with high food insecurity and reduced access to grocery with poorer food allergy management. Specifically, we hypothesize that the food environment will a statistically significant percentage of the differences in FA diagnosis and management. Significance and Effects on Other Research: This will be the first study to systematically examine disparities in FA diagnosis and management among privately and publicly insured children and the first to leverage existing data to explore the impact of the food environment on disparities. The food environment represents a potentially modifiable target of intervention to ameliorate disparities in guideline-based allergy care and reduce unintentional allergic reactions.