Ortega Alexander N, Gergen Peter J, Paltiel A David, Bauchner Howard, Belanger Kathleen D, Leaderer Brian P
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA.
Pediatrics. 2002 Jan;109(1):E1. doi: 10.1542/peds.109.1.e1.
To understand the importance of source of care and other factors that influence differences in asthma medication use by race and Hispanic ethnicity.
The Childhood Asthma Severity Study provided 12-month, retrospective, parent-reported questionnaire data on a monthly basis for children ages </=12 years in a community sample of 1002 children and their families from Connecticut and Massachusetts. Medications considered included cromolyn, beta2-agonist, inhaled steroids, anticholinergics, theophylline, and systemic steroids. Information was available on demographics, insurance status, symptom severity, primary care contact, and provider practice types.
Black and Hispanic children received fewer beta2-agonists, and Hispanic children received fewer inhaled steroids than white children after adjusting for patients' race, age, gender, insurance status, symptom severity, number of primary care visits for asthma, number of urgent visits to the regular provider, family income, maternal education, and site of care. When multivariate analyses were restricted to patients in private practice, the significant association between Hispanic ethnicity and low inhaled steroid use persisted, whereas differences in beta2-agonist use by race and ethnicity changed little but became nonsignificant.
Even within private practices, patients' race and ethnicity are associated with clinician nonadherence to national guidelines. Programs to eliminate these disparities will need both to focus on site of care and to intervene at the provider and patient levels to be successful.
了解就医来源以及其他影响哮喘药物使用种族和西班牙裔差异的因素的重要性。
儿童哮喘严重程度研究提供了为期12个月的回顾性家长报告问卷调查数据，这些数据是关于来自康涅狄格州和马萨诸塞州的1002名儿童及其家庭的社区样本中年龄≤12岁儿童的每月情况。所考虑的药物包括色甘酸钠、β2激动剂、吸入性类固醇、抗胆碱能药物、茶碱和全身性类固醇。可获得的信息包括人口统计学、保险状况、症状严重程度、初级保健联系人以及医疗服务提供者的执业类型。
在对患者的种族、年龄、性别、保险状况、症状严重程度、哮喘初级保健就诊次数、定期医疗服务提供者的紧急就诊次数、家庭收入、母亲教育程度和就医地点进行调整后，黑人和西班牙裔儿童使用β2激动剂的次数少于白人儿童，西班牙裔儿童使用吸入性类固醇的次数少于白人儿童。当多变量分析仅限于私人执业的患者时，西班牙裔与低吸入性类固醇使用之间的显著关联仍然存在，而种族和族裔在β2激动剂使用上的差异变化不大但变得不显著。
即使在私人执业环境中，患者的种族和族裔也与临床医生不遵守国家指南有关。消除这些差异的项目需要既关注就医地点，又要在医疗服务提供者和患者层面进行干预才能取得成功。
