Netuveli Gopalakrishnan, Hurwitz Brian, Levy Mark, Fletcher Monica, Barnes Greta, Durham Stephen R, Sheikh Aziz
Department of Primary Care & Social Medicine, Imperial College London, London, UK.
Lancet. 2005;365(9456):312-7. doi: 10.1016/S0140-6736(05)17785-X.
The frequency of asthma varies between countries, and may also vary between ethnic groups in more geographically confined areas. We sought evidence of such ethnic variations in the UK for asthma frequency, morbidity, and health-services use, and to understand possible reasons for any differences.
We searched MEDLINE, EMBASE, CINAHL, PSYCHInfo, PREMEDLINE, HEALTHSTAR, Cambridge Register of Conference Abstracts, the Dissertation and Thesis Database, and the National Registry of Research. Additionally, we searched the bibliographies of reports identified and websites of health authorities, and contacted experts in this discipline. Our main outcomes were comparisons of asthma rate, morbidity, and health-services use. We did meta-analyses using random-effects models.
13 studies contained relevant data. All prevalence studies were of children and showed that south Asian children had a lower frequency of symptoms suggestive of asthma compared with black and white children (pooled rate of history of wheeze in the previous 12 months: south Asians 9.6% [95%CI 8.0-11.2%], black people 16.2% [12.8-19.6%], white people 14.6% [11.5-17.8%]). The pooled frequency of clinician-diagnosed asthma in children followed a similar pattern (south Asians 7.6% [3.7-11.4%], black people 15.0% [3.5-26.5%], white people 10.6% [4.6-16.7%]. However, relative to white people, the risk of admission for asthma in children and adults was higher for south Asians (odds ratio 2.9 [2.4-3.4]) and black people (2.1 [1.8-2.5]).
The differences in admission are not explained by differences in asthma frequency between groups; they could relate to ethnic variations in asthma severity, differences in health-seeking behaviour, or difficulties in accessing high-quality primary care services.
哮喘的发病率在不同国家之间存在差异，在地理区域更为有限的地区，不同种族群体之间也可能存在差异。我们试图寻找英国哮喘发病率、发病率及医疗服务使用方面种族差异的证据，并了解造成这些差异的可能原因。
我们检索了MEDLINE、EMBASE、CINAHL、PSYCHInfo、PREMEDLINE、HEALTHSTAR、剑桥会议摘要登记册、学位论文数据库和国家研究登记册。此外，我们还检索了已识别报告的参考文献和卫生当局的网站，并联系了该领域的专家。我们的主要结果是对哮喘发病率、发病率及医疗服务使用情况进行比较。我们使用随机效应模型进行荟萃分析。
13项研究包含相关数据。所有患病率研究均针对儿童，结果显示，与黑人和白人儿童相比，南亚儿童出现提示哮喘症状的频率较低（过去12个月喘息病史的合并率：南亚人9.6%[95%置信区间8.0-11.2%]，黑人16.2%[12.8-19.6%]，白人14.6%[11.5-17.8%]）。儿童中临床诊断哮喘的合并频率也呈现类似模式（南亚人7.6%[3.7-11.4%]，黑人15.0%[3.5-26.5%]，白人10.6%[4.6-16.7%]）。然而，相对于白人，南亚儿童和成人因哮喘入院的风险高于黑人（优势比2.9[2.4-3.4]）和黑人（2.1[1.8-2.5]）。
入院差异并非由各组哮喘发病率的差异所解释；它们可能与哮喘严重程度的种族差异、就医行为差异或获得高质量初级医疗服务的困难有关。
