Krishnan J A, Diette G B, Skinner E A, Clark B D, Steinwachs D, Wu A W
Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Cir, Room 4B.74, Baltimore, MD 21224, USA.
Arch Intern Med. 2001 Jul 9;161(13):1660-8. doi: 10.1001/archinte.161.13.1660.
In the United States, morbidity from asthma disproportionately affects African Americans and women. Although inadequate care contributes to overall asthma morbidity, less is known about differences in asthma care by race and sex.
To examine the relationships of race and sex with asthma care, we analyzed responses to questionnaires administered to adults enrolled in 16 managed care organizations participating in the Outcomes Management System Asthma Study between September and December 1993. Indicators of care consistent with National Asthma Education and Prevention Program (1991) recommendations were assessed. Of a random sample of 8640 patients asked to participate, 6612 (77%) completed the survey. This study focused on 5062 (14% African American, 72% women) patients with at least moderate asthma symptom severity.
Fewer African Americans than whites reported care consistent with recommendations for medication use (eg, daily inhaled corticosteroid use, 34.9% vs 54.4%; P =.001), self-management education (eg, action plan, 42.0% vs 53.8%; P =.001), avoiding triggers (37.6% vs 53.6%; P =.001), and specialist care (28.3% vs 41.0%; P =.001). Differences in asthma care by sex were smaller and tended to favor women except for daily inhaled corticosteroid use (women vs men: 49.6% vs 58.3%; P =.001) and having specialist care (37.7% vs 43.1%; P =.001). Similar race and sex differences were observed after adjusting for age, education, employment, and symptom frequency.
Even among patients with health insurance, disparities in asthma care for African Americans compared with whites exist and may contribute to race disparities in outcomes. Women generally reported better asthma care but may benefit from greater use of inhaled corticosteroids.
在美国，哮喘发病率对非裔美国人及女性的影响尤为严重。尽管护理不足是导致整体哮喘发病率的一个因素，但关于种族和性别在哮喘护理方面的差异，人们了解得较少。
为了研究种族和性别与哮喘护理之间的关系，我们分析了对参与1993年9月至12月结果管理系统哮喘研究的16个管理式医疗组织中成年患者所进行问卷调查的回复。评估了符合国家哮喘教育与预防计划（1991年）建议的护理指标。在随机抽取的8640名受邀参与调查的患者中，6612名（77%）完成了调查。本研究聚焦于5062名（14%为非裔美国人，72%为女性）哮喘症状至少为中度严重程度的患者。
报告的符合药物使用建议（如每日吸入糖皮质激素使用，34.9%对54.4%；P = 0.001）、自我管理教育（如行动计划，42.0%对53.8%；P = 0.001）、避免触发因素（37.6%对53.6%；P = 0.001）以及专科护理（28.3%对41.0%；P = 0.001）的非裔美国人少于白人。性别在哮喘护理方面的差异较小，除了每日吸入糖皮质激素使用（女性对男性：49.6%对58.3%；P = 0.001）和接受专科护理（37.7%对43.1%；P = 0.001）外，女性往往更具优势。在对年龄、教育程度、就业情况和症状频率进行调整后，观察到了类似的种族和性别差异。
即使在有医疗保险的患者中，非裔美国人与白人在哮喘护理方面仍存在差异，这可能导致了种族在治疗结果上的差异。女性总体上报告的哮喘护理情况较好，但可能会从更多使用吸入糖皮质激素中受益。
