Lutfiyya May Nawal, McCullough Joel Emery, Lipsky Martin Stephen
Research Division, Essentia Institute of Rural Health, Duluth, MN 55805, USA.
J Asthma. 2011 Nov;48(9):931-44. doi: 10.3109/02770903.2011.619023. Epub 2011 Oct 4.
Asthma prevalence in the United States is higher than it is in many other countries and its impact in terms of healthcare expenditures and morbidity and mortality is staggering. In the United States, many groups bear a disproportionate burden of asthma. Understanding the epidemiology of adult asthma and deficits in health care can identify opportunities for improving care and effectively managing resources.
The computed dependent variable, health service deficits, entails a lack of health insurance, not having a healthcare provider, deferring medical care because of cost, and having had no routine medical exam. Bivariate and multivariate analyses were performed on 2005 Behavioral Risk Factor Surveillance Survey data to examine the relationship between health service deficits experienced by adults with asthma and socioeconomic status (SES), race and ethnicity, and geographic locale. The variable was also calculated for each US state.
Hispanic (OR = 1.594, 95% CI = 1.588-1.599) and Other/Multiracial (OR = 1.447, 95% CI = 1.441-1.452) adults with current asthma had greater odds of having a health service deficit. Rural adults with current asthma had greater odds of having a health service deficit (OR = 1.086, 95% CI = 1.083-1.089) when compared with non-rural adult residents. Low-SES (OR = 1.976, 95% CI = 1.971-1.982) and middle-SES (OR = 1.596, 95% CI = 1.592-1.600) adults with current asthma had greater odds of having a health service deficit. The percentage of current asthma adults experiencing at least one health service deficit by state ranged from a low of 28.5% (Delaware) to a high of 58.8% (Wyoming).
There are clear patterns of disparity associated with health services and asthma that can help target interventions.
美国哮喘患病率高于许多其他国家，其在医疗保健支出、发病率和死亡率方面的影响惊人。在美国，许多群体承受着不成比例的哮喘负担。了解成人哮喘的流行病学和医疗保健方面的不足可以确定改善护理和有效管理资源的机会。
计算得出的因变量“医疗服务不足”包括缺乏医疗保险、没有医疗服务提供者、因费用问题推迟医疗护理以及没有进行常规体检。对2005年行为危险因素监测调查数据进行双变量和多变量分析，以研究患有哮喘的成年人所经历的医疗服务不足与社会经济地位（SES）、种族和民族以及地理位置之间的关系。还计算了美国每个州的该变量。
患有当前哮喘的西班牙裔成年人（比值比[OR]=1.594，95%置信区间[CI]=1.588 - 1.599）和其他/多种族成年人（OR = 1.447，95% CI = 1.441 - 1.452）出现医疗服务不足的几率更高。与非农村成年居民相比，患有当前哮喘的农村成年人出现医疗服务不足的几率更高（OR = 1.086，95% CI = 1.083 - 1.089）。患有当前哮喘的低社会经济地位成年人（OR = 1.九76，95% CI = 1.971 - 1.982）和中等社会经济地位成年人（OR = 1.596，95% CI = 1.592 - 1.600）出现医疗服务不足的几率更高。按州划分，患有当前哮喘且至少经历一项医疗服务不足的成年人比例从低的28.5%（特拉华州）到高的58.8%（怀俄明州）不等。
与医疗服务和哮喘相关的差异模式明显，有助于确定干预目标。
