Canino Glorisa, McQuaid Elizabeth L, Alvarez Maria, Colon Angel, Esteban Cynthia, Febo Vivian, Klein Robert B, Mitchell Daphne Koinis, Kopel Sheryl J, Montealegre Federico, Ortega Alexander N, Rodriguez-Santana Jose, Seifer Ronald, Fritz Gregory K
Behavioral Sciences Research Institute, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
Pediatr Pulmonol. 2009 Sep;44(9):899-908. doi: 10.1002/ppul.21075.
Epidemiologic studies have documented higher rates of asthma prevalence and morbidity in minority children compared to non-Latino white (NLW) children. Few studies focus on the mechanisms involved in explaining this disparity, and fewer still on the methodological challenges involved in rigorous disparities research.
This article provides an overview of challenges and potential solutions to research design for studies of health disparities. The methodological issues described in this article were framed on an empirical model of asthma health disparities that views disparities as resulting from several factors related to the healthcare system and the individual/community system. The methods used in the Rhode Island-Puerto Rico Asthma Center are provided as examples, illustrating the challenges in executing disparities research.
Several methods are described: distinguishing ethnic/racial differences from methodological artifacts, identifying and adapting culturally sensitive measures to explain disparities, and addressing the challenges involved in determining asthma and its severity in Latino and other minority children. The measures employed are framed within each of the components of the conceptual model presented.
Understanding ethnic and/or cultural disparities in asthma morbidity is a complicated process. Methodologic approaches to studying the problem must reflect this complexity, allowing us to move from documenting disparities to understanding them, and ultimately to reducing them.
流行病学研究表明，与非拉丁裔白人（NLW）儿童相比，少数族裔儿童哮喘的患病率和发病率更高。很少有研究关注解释这种差异的机制，而关注严格的差异研究中所涉及的方法学挑战的研究更少。
本文概述了健康差异研究设计的挑战及潜在解决方案。本文所描述的方法学问题是基于哮喘健康差异的实证模型，该模型认为差异是由与医疗系统及个人/社区系统相关的几个因素导致的。以罗德岛 - 波多黎各哮喘中心所使用的方法为例，阐述了开展差异研究的挑战。
介绍了几种方法：区分种族/民族差异与方法学假象，识别并采用文化敏感措施来解释差异，以及应对在确定拉丁裔和其他少数族裔儿童哮喘及其严重程度方面所涉及的挑战。所采用的措施是在提出的概念模型的每个组成部分范围内制定的。
了解哮喘发病率中的种族和/或文化差异是一个复杂的过程。研究该问题的方法学途径必须反映这种复杂性，使我们能够从记录差异转向理解差异，并最终减少差异。
