Newcomb Patricia, Li Jianling
University of Texas-Arlington, School of Nursing, Arlington, TX, USA.
J Nurs Scholarsh. 2008;40(4):319-25. doi: 10.1111/j.1547-5069.2008.00245.x.
This retrospective study is an investigation of the relationship between traffic exposure and childhood asthma exacerbations in a previously unstudied geographic area. We hypothesized that, controlling for selected demographic and social factors, exposure to traffic emissions would allow the prediction of hospital utilization for children with asthma.
Using hospital and emergency department (ED) records, we investigated the relationship between proximity to major roadways and admissions for asthma exacerbations in the Fort Worth metropolitan area, designated as not attaining federal air health standards. The sample included 2,357 children from 1 to 12 years of age admitted for emergency or inpatient treatment in a 288-bed, nonprofit children's medical center in Fort Worth, Texas from January 1, 2004 to December 31, 2005. Data were analyzed using GIS mapping and logistic regression.
Deidentification data were collected from hospital databases after IRB approval and waiver of parental permission or patient consent. Student's t test was used to compare groups with and without primary asthma diagnosis on admission in respect to distance from major roadways. Logistic regression was used to model relationships between asthma admission and patients' characteristics, exposure to traffic, and social environment.
Controlling for several demographic factors, asthma occurrences were positively related to traffic exposures. On average, patients with asthma lived closer to major roadways than did patients who did not have asthma. Patients with asthma also tended to live in neighborhoods with more roads than did those who did not have asthma; 3/4 of the children admitted for asthma during the study period and less than 1/3 of the children admitted for nonasthma diagnoses lived within 1,500 meters of a major roadway (p=.0001). Controlling for other factors, every meter increase in proximity to major roadways produced 0.1% increase in likelihood of admission.
Knowledge of risk factors and their relative magnitudes enable nurses to better tailor symptom management for individual patients.
本回顾性研究旨在调查一个此前未被研究过的地理区域内交通暴露与儿童哮喘急性发作之间的关系。我们假设，在控制选定的人口统计学和社会因素后，交通排放暴露能够预测哮喘儿童的住院率。
利用医院和急诊科记录，我们调查了得克萨斯州沃思堡市大都市区内靠近主要道路与哮喘急性发作入院之间的关系，该地区未达到联邦空气健康标准。样本包括2004年1月1日至2005年12月31日期间在得克萨斯州沃思堡市一家拥有288张床位的非营利性儿童医疗中心因急诊或住院治疗而入院的2357名1至12岁儿童。使用地理信息系统绘图和逻辑回归对数据进行分析。
在获得机构审查委员会批准并豁免家长许可或患者同意后，从医院数据库中收集去识别化数据。采用学生t检验比较入院时患有和未患有原发性哮喘诊断的两组儿童与主要道路的距离。采用逻辑回归对哮喘入院与患者特征、交通暴露和社会环境之间的关系进行建模。
在控制了几个人口统计学因素后，哮喘发作与交通暴露呈正相关。平均而言，哮喘患者比没有哮喘的患者居住得更靠近主要道路。哮喘患者居住的社区道路也往往比没有哮喘的患者更多；研究期间因哮喘入院的儿童中有3/4以及因非哮喘诊断入院的儿童中不到1/3居住在距离主要道路1500米以内（p = 0.0001）。在控制其他因素后，与主要道路的距离每增加一米，入院可能性增加0.1%。
了解风险因素及其相对大小使护士能够更好地为个体患者量身定制症状管理方案。
