Bauman Laurie J, Wright Elizabeth, Leickly Frederick E, Crain Ellen, Kruszon-Moran Deanna, Wade Shari L, Visness Cynthia M
Department of Pediatrics, Albert Einstein College of Medicine and the Children's Hospital at Montefiore, Bronx, New York, USA.
Pediatrics. 2002 Jul;110(1 Pt 1):e6. doi: 10.1542/peds.110.1.e6.
Morbidity from asthma among children is one of the most important US health concerns. This study examines the relationship of baseline nonadherence to subsequent asthma morbidity among inner-city children.
A multisite, prospective, longitudinal panel study was conducted of 1199 children who were aged 4 to 9 years and had asthma and their caregivers, most of whom were parents, in emergency departments and clinics at 8 research centers in 7 US metropolitan inner-city areas. Nine morbidity indicators were collected at 3, 6, and 9 months after baseline, including hospitalizations, unscheduled visits, days of wheeze/cough, and days of reduced activities.
Children whose caregivers scored high on a new measure, Admitted Nonadherence, experienced significantly worse morbidity on 8 of the 9 measures. Children who scored high on a new Risk for Nonadherence measure experienced significantly worse morbidity on all 9 morbidity measures. Multiple and logistic regressions found that the adherence measures had independent significant effects on morbidity. Combining the measures improved estimates of morbidity: children whose caregivers were poor on either adherence measure had worse morbidity than those with good adherence on both, eg, rate of hospitalization was twice as high, they missed more than twice as much school, had poorer overall functioning, and experienced more days of wheezing and more restricted days of activity.
Risk for Nonadherence and Admitted Nonadherence independently and jointly predicted subsequent asthma morbidity. Targeting risks for nonadherence may be an effective intervention strategy. Most risks can be controlled by physicians through reducing the complexity of asthma regimens, communicating effectively with caregivers about medication use, and correcting family misconceptions about asthma medication side effects.
儿童哮喘发病率是美国最重要的健康问题之一。本研究调查了美国城市中心区儿童基线期治疗依从性差与后续哮喘发病率之间的关系。
对美国7个大城市中心区8个研究中心的急诊科和诊所中1199名4至9岁的哮喘儿童及其照顾者（大多数为父母）进行了一项多地点、前瞻性、纵向队列研究。在基线期后的3个月、6个月和9个月收集了9项发病率指标，包括住院次数、非计划就诊次数、喘息/咳嗽天数以及活动减少天数。
在一项新的测量指标“承认的不依从”上得分高的儿童照顾者，其孩子在9项指标中的8项上发病率显著更高。在一项新的“不依从风险”测量指标上得分高的儿童，在所有9项发病率指标上发病率均显著更高。多元回归和逻辑回归发现，依从性测量指标对发病率有独立的显著影响。综合这些指标可更好地估计发病率：在任何一项依从性测量指标上表现差的儿童照顾者，其孩子的发病率都高于两项指标表现都好的照顾者的孩子，例如，住院率高出两倍，缺课天数多出两倍多，整体功能较差，喘息天数更多，活动受限天数更多。
“不依从风险”和“承认的不依从”独立且共同预测了后续哮喘发病率。针对不依从风险可能是一种有效的干预策略。大多数风险可由医生通过降低哮喘治疗方案的复杂性、就用药问题与照顾者进行有效沟通以及纠正家庭对哮喘药物副作用的误解来控制。
