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

项目总结和摘要 背景：食物过敏（FA）是一种潜在的危及生命的慢性疾病，影响约32 100万美国儿童和成人。虽然估计7.6%的美国儿童患有FA，但非裔美国人非FA 西班牙裔儿童相对于非西班牙裔白色儿童的风险显著升高。儿童 参加医疗补助计划，种族和民族与FA相关，例如亚洲人，黑人， 与白色儿童相比，太平洋岛民/夏威夷原住民儿童FA的比值更高。此外，本发明还提供了一种方法， 在FA的经济负担和FA的可能性方面， 接受基于指南的过敏护理。虽然差距的证据越来越多，但很少有研究表明， 研究了差异的来源，特别是可改变的因素，如当地食物的特点， 环境，没有人使用私人保险儿童的大量行政数据。 具体目的和方法：本研究的主要目的如下：1）测量种族和性别的差异， 美国儿童FA诊断和管理的种族、收入和地理差异，2） 评估社会、经济和环境因素对差距的贡献，3）确定区域热点 美国食物过敏儿童的FA诊断和管理结果。本研究将 利用两个互补的管理数据来检查差异：医疗补助和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。的 TAF中的研究人群将包括至少49个州参加医疗补助计划的所有儿童， 哥伦比亚特区。HCCI数据将包括雇主赞助的保险索赔约11 美国0-17岁的儿童。县级特色大学将借鉴 威斯康星州人口健康研究所的县健康排名和路线图和美国农业部的食品 环境地图集。实证方法将使用《2001 - 2003年国际人口与发展报告》中提出的种族和族裔差异框架， 医学研究所（IOM）2003年报告，不平等待遇。 假设和预期结果：我们 关联 店 解释 主要研究假设基于一个概念模型 危险的粮食环境，包括粮食高度不安全和获得杂货的机会减少的地区 对食物过敏的管理也很差具体来说，我们假设食品环境将 FA诊断和管理差异的统计学显著百分比。 对其他研究的意义和影响：这将是第一项系统研究差异的研究 在FA诊断和管理中，私人和公共保险的儿童和第一个利用 现有的数据，探讨粮食环境对差距的影响。食品环境是一个 潜在的可修改的干预目标，以改善基于指南的过敏护理的差异， 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.