Straus W L, Eisen G M, Sandler R S, Murray S C, Sessions J T
Department of Medicine and Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, USA.
Am J Gastroenterol. 2000 Feb;95(2):479-83. doi: 10.1111/j.1572-0241.2000.t01-1-01531.x.
The severity of Crohn's disease (CD) has been reported to be greater in blacks than in whites. This possible disparity may be due, in part, to differences between these groups in health care utilization and accessibility. To explore these issues, we conducted a multicenter survey of patients with CD.
One-hundred and forty-five blacks with CD, recruited from four teaching hospitals and five private practices, and identified by medical record review or ICD-9 code, were enrolled and matched to 407 whites with CD (by age, gender, and practice type [teaching vs. private practice setting]). Participants were interviewed regarding medical history, health status, personal health care practices during the preceding 5 yr, and beliefs regarding health care in the general population.
Blacks and whites were similar with respect to age of CD onset, lag in time to diagnosis, and number of gastrointestinal (GI)-related hospitalizations and surgeries. Medication usage patterns were also similar in the two groups. Quality of life, measured by SF-36, was lower in all categories for blacks, compared with whites. Blacks were more likely to have had to stop work (p<0.01) and have lost more work days (p<0.01) than were whites. Whites were more likely to have health insurance and be able to identify a regular provider than were blacks. Blacks were more likely to report the following: receiving Medicaid; difficulty affording health care; delaying appointments due to financial concerns; difficulty traveling to their provider's office; and experiencing unreasonable delays at their provider's office. After adjusting for potential confounding variables, we found no differences between the groups, except for the number of days of work lost because of CD.
These data suggest that black and white patients have similar reported disease presentations and course, and contrast with prior reports suggesting a more severe disease course among black patients. Although the disease itself appears similar, there were numerous reported differences between the races in health care utilization practices and in disease impact upon daily activities. We suggest that apparent disparities in CD according to race are actually due to social and economic factors, and not to the disease itself.
据报道，克罗恩病（CD）在黑人中的严重程度高于白人。这种可能存在的差异部分可能归因于这两个群体在医疗保健利用和可及性方面的差异。为探讨这些问题，我们对CD患者进行了一项多中心调查。
从四家教学医院和五家私人诊所招募了145名患有CD的黑人，通过病历审查或国际疾病分类第九版（ICD - 9）编码进行识别，并与407名患有CD的白人（按年龄、性别和执业类型[教学机构与私人诊所环境]）进行匹配。就病史、健康状况、过去5年的个人医疗保健习惯以及对普通人群医疗保健的看法对参与者进行了访谈。
黑人和白人在CD发病年龄、诊断延迟时间以及胃肠道（GI）相关住院和手术次数方面相似。两组的用药模式也相似。通过SF - 36量表测量，黑人在所有类别中的生活质量均低于白人。与白人相比，黑人更有可能不得不停止工作（p<0.01）且损失更多工作日（p<0.01）。白人比黑人更有可能拥有医疗保险并能确定一位固定的医疗服务提供者。黑人更有可能报告以下情况：接受医疗补助；难以负担医疗保健费用；因经济担忧而推迟预约；前往医疗服务提供者办公室困难；以及在医疗服务提供者办公室经历不合理的延迟。在对潜在混杂变量进行调整后，我们发现除了因CD而损失的工作日数外，两组之间没有差异。
这些数据表明，黑人和白人患者报告的疾病表现和病程相似，这与之前关于黑人患者疾病病程更严重的报告形成对比。尽管疾病本身看起来相似，但据报告，不同种族在医疗保健利用习惯以及疾病对日常活动的影响方面存在许多差异。我们认为，CD中明显的种族差异实际上是由于社会和经济因素，而非疾病本身。
