Jones Rena, Lin Shao, Munsie Jean Pierre, Radigan Marleen, Hwang Syni-An
New York State Department of Health, Bureau of Environmental and Occupational Epidemiology, Troy, NY 12180, USA.
J Asthma. 2008 Dec;45(10):916-22. doi: 10.1080/02770900802395488.
This study examined whether racial/ethnic minority (i.e., Black, Hispanic) children with wheeze have a higher proportion of urgent care use (i.e., emergency department visit or hospitalization) for asthma compared to their White counterparts. We also assessed the contribution of disease severity and sociodemographic, access to care, and home environmental risk factors to racial/ethnic differences in utilization. A cross-sectional study was conducted among children aged 0 to 17 in Buffalo, New York. We compared rates of urgent care visits and physician-diagnosed asthma among racial/ethnic groups, and conducted race/ethnicity stratified analyses by number of symptoms, asthma severity, insurance types, and medical care access. Multivariate regression analyses were used to examine differences in urgent care use by race/ethnicity after controlling for multiple confounders and to identify factors associated with urgent care utilization by race/ethnicity. Asthma symptom severity was the primary factor contributing to urgent care use in this population, followed by race/ethnicity and Medicaid enrollment. Minority children with wheeze were nearly twice as likely as Whites to have used urgent care for asthma, after controlling for disease severity, access to care, and environmental factors. Not having a home remedy in place for asthma or reporting trouble getting care also contributed to the greater use of urgent care resources among minority children. Minority children still had a significantly higher proportion of urgent care use for acute asthma care compared to Whites, even after controlling for multiple risk factors. Disease severity and inadequate access to medical care may partially explain higher rates among minority children. Future studies should examine racial/ethnic differences in other factors potentially associated with urgent care use, including asthma management and use of routine asthma care.
本研究调查了患有喘息的种族/族裔少数群体（即黑人、西班牙裔）儿童与白人儿童相比，因哮喘而使用紧急护理（即急诊就诊或住院）的比例是否更高。我们还评估了疾病严重程度、社会人口统计学、就医机会和家庭环境风险因素对种族/族裔在医疗利用方面差异的影响。在纽约州布法罗市对0至17岁的儿童进行了一项横断面研究。我们比较了种族/族裔群体中紧急护理就诊率和医生诊断的哮喘患病率，并按症状数量、哮喘严重程度、保险类型和医疗服务可及性进行了种族/族裔分层分析。多元回归分析用于在控制多个混杂因素后检验种族/族裔在紧急护理使用方面的差异，并确定与种族/族裔紧急护理利用相关的因素。哮喘症状严重程度是导致该人群使用紧急护理的主要因素，其次是种族/族裔和医疗补助登记情况。在控制了疾病严重程度、就医机会和环境因素后，患有喘息的少数族裔儿童因哮喘使用紧急护理的可能性几乎是白人儿童的两倍。没有针对哮喘的家庭疗法或报告就医困难也导致少数族裔儿童更多地使用紧急护理资源。即使在控制了多个风险因素之后，少数族裔儿童因急性哮喘护理而使用紧急护理的比例仍显著高于白人。疾病严重程度和医疗服务可及性不足可能部分解释了少数族裔儿童的较高使用率。未来的研究应调查其他可能与紧急护理使用相关的因素中的种族/族裔差异，包括哮喘管理和常规哮喘护理的使用情况。
