Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Ann Allergy Asthma Immunol. 2011 Jun;106(6):467-73. doi: 10.1016/j.anai.2011.02.013. Epub 2011 Apr 8.
Urban children represent a group at high risk for asthma development and adverse asthma outcomes. Although rural children also encounter sociodemographic disparities that might be expected to worsen asthma, asthma in the rural United States is poorly studied.
To determine rural-urban differences in childhood asthma diagnosis and morbidity.
We studied a statewide population of 117,080 children continuously enrolled in Tennessee Medicaid from birth through the sixth year of life, using linked Tennessee Medicaid, vital records, and pharmacy claims databases to determine asthma diagnosis and residence.
The cohort was 45% urban, 23% suburban, and 33% rural. Compared with urban children, rural children were more likely to be white, have a history of bronchiolitis, and have mothers who smoked. Eleven percent of urban, 12% of suburban, and 13% of rural children met study criteria for asthma diagnosis (adjusted odds ratio for rural children, 1.16; 95% confidence interval, 1.09-1.24; adjusted odds ratio for suburban children, 1.22; 95% confidence interval, 1.14-1.30; with urban as the referent; P < .001). Rural children had greater use of outpatient asthma care, whereas urban children had greater use of inhaled corticosteroids. Compared with urban children, rural children had fewer asthma emergency department visits but were hospitalized for asthma at similar rates and had similar use of asthma rescue medications.
In this pediatric Medicaid population, rural children had increased asthma prevalence and similar asthma morbidity compared with urban children but differences in patterns of asthma care and resource use, suggesting that optimal interventions for asthma may differ in rural compared with urban populations.
城市儿童是哮喘发病和不良哮喘结局的高危群体。尽管农村儿童也面临可能导致哮喘恶化的社会人口差异，但美国农村的哮喘研究甚少。
确定城乡儿童哮喘诊断和发病的差异。
我们对田纳西州医疗补助计划中 117080 名连续从出生到 6 岁的儿童进行了全州范围内的研究，使用链接的田纳西州医疗补助计划、生命记录和药房理赔数据库来确定哮喘诊断和居住地点。
队列中 45%为城市儿童，23%为郊区儿童，33%为农村儿童。与城市儿童相比，农村儿童更可能是白人，有细支气管炎病史，母亲吸烟。11%的城市儿童、12%的郊区儿童和 13%的农村儿童符合哮喘诊断标准（农村儿童的调整后优势比为 1.16；95%置信区间为 1.09-1.24；郊区儿童的调整后优势比为 1.22；95%置信区间为 1.14-1.30；以城市儿童为参照；均<.001）。农村儿童更频繁地接受门诊哮喘治疗，而城市儿童更频繁地使用吸入皮质激素。与城市儿童相比，农村儿童急诊就诊次数较少，但因哮喘住院的比例相似，且使用哮喘急救药物的情况相似。
在这项儿科医疗补助计划人群中，农村儿童的哮喘患病率高于城市儿童，但哮喘发病的模式和资源利用存在差异，这表明农村与城市人群的哮喘干预措施可能存在差异。
