DISPARITIES IN ASTHMA AMONG ELDERLY IN WEST TEXAS

哮喘的患病率在美国和世界范围内都在增加。从1980年到1994年，美国的患病率增加了75%。据报道，65岁及以上的老年人中哮喘的患病率为7%至10%。然而，这一估计可能被低估了，因为有证据表明哮喘在老年人中诊断不足。西班牙裔是美国增长最快的少数民族，但很少有研究涉及西班牙裔样本，特别是 老人德克萨斯理工大学5000调查是一项基于5000名西德克萨斯州老年居民的大型人群纵向流行病学研究。德克萨斯理工大学5000样本是从德克萨斯州西部108个县的居民家庭电话列表中随机抽取的。我们建议对德克萨斯理工大学5000的wave-3进行二次数据分析 调查，这将使我们能够评估这一人群中哮喘、哮喘症状和过敏的患病率、预测因素和后果。德克萨斯理工大学5000调查的第三波是从2001年10月到2001年12月进行的。共有3392名受试者参与了调查，应答率为86.7%。样本包括大约12%的西班牙裔。本分析的具体目的是1）估计和比较老年人中哮喘、哮喘症状和过敏的患病率，2）检验西班牙裔老年人和农村地区老年人中哮喘症状不太可能导致医学评估、诊断和治疗的假设，3）评估哮喘和哮喘症状对日常生活的影响，使用通用（SF-12）和 哮喘特异性健康相关生活质量（HRQoL）问卷，和4）确定和比较患有和不患有哮喘的受试者使用的处方药的平均成本以及药物成本如何影响生活质量。为了定义哮喘，将使用两个操作定义：明确的哮喘（基于医生诊断）和可能的哮喘（基于哮喘症状）。将计算并比较哮喘受试者和非哮喘受试者的健康相关生活质量平均评分和平均就诊次数。将使用logistic回归分析哮喘（明确的和很可能的）与独立变量之间的相关性，这些独立变量分为5类：1）社会人口统计学变量，2）环境和家庭特征，3）过敏，4）哮喘症状和5）医疗保健获取。将比较老年西班牙裔和非西班牙裔哮喘症状受试者在医疗保健可及性方面的比例，包括使用卡方统计进行医学评估和诊断。还将进行类似的比较，以评估城乡差别。

The prevalence of asthma has been increasing both in the US and worldwide. The prevalence increased by 75% in the U.S. from 1980 to1994. The prevalence of asthma among elderly aged 65 and above is reported to be 7% to 10%. However, this estimate may be an underestimate since there is evidence that asthma is under-diagnosed in the elderly. Hispanics are the fastest growing minority in the US, yet very few studies involve Hispanic samples, especially the elderly. The Texas Tech 5000 survey is a large population based longitudinal epidemiological study of 5000 elderly West Texas residents. The Texas Tech 5000 sample was randomly selected from residential household telephone listings in the 108 counties of West Texas. We propose to conduct a secondary data analysis of the wave-3 of the Texas Tech 5000 survey, which will permit us to assess the prevalence, predictors, and consequences of asthma, asthma symptoms and allergy in this population. The wave-3 of the Texas Tech 5000 survey was conducted from October 20001 through December 2001. A total of 3392 subjects participated in the survey for a response rate of 86.7%. The sample includes approximately 12% Hispanics. The specific objectives of this analysis are 1) to estimate and compare the revalence of asthma, asthma symptoms, and allergies among the elderly persons, 2) to test hypotheses that asthma symptoms are less likely to result in medical assessment, diagnosis and treatment among Hispanic elderly persons and among elderly persons in rural areas, 3) to assess impact of asthma and asthma symptoms on daily life, using generic (SF-12) and asthma specific health related quality of life (HRQoL) questionnaire, and 4) to determine and compare the average cost of prescription medicine used by subjects with and without asthma and how the cost of medication affects quality of life. To define asthma, two operational definitions will be used: definite asthma (based on physician-diagnosis) and probable asthma (based on asthma symptoms). Mean scores on health related quality of life, and mean number of physician office visits will be computed and compared among subjects with and without asthma. The association between asthma (definite and probable) and independent variables grouped into five categories: 1) socio-demographic variables, 2) environmental and household characteristics, 3) allergies, 4) asthma symptoms, and 5) health care access, will be analyzed using logistic regression. Proportion of elderly Hispanics and non-Hispanic subjects with asthma symptoms will be compared with regard to health care access, including medical assessment and diagnosis using chi-square statistics. A similar comparison will be made to evaluate urban/rural differences.