Divisions of General and Community Pediatrics.
Pediatrics. 2014 Mar;133(3):431-9. doi: 10.1542/peds.2013-2437. Epub 2014 Feb 2.
Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models.
We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded. Analyses used Cox proportional hazards.
The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being single/never married (all P ≤ .01). Hardships explained 41% of the observed racial disparity in readmission; jointly, socioeconomic status and hardship explained 49%.
African American children were twice as likely to be readmitted as white children; hardships explained >40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity.
医疗改革提供了一个解决儿童健康差异的新机会。本研究旨在描述儿科哮喘再入院的种族差异，并重点关注未来患者护理模式中可能解决的困难的潜在解释作用。
我们纳入了 774 名年龄在 1 至 16 岁之间、因哮喘或支气管扩张剂反应性喘息而住院的儿童，这些儿童均来自基于人群的前瞻性观察队列。主要结局为再入院时间。记录了儿童种族、社会经济地位（由低收入和照顾者教育程度衡量）和困难（照顾者找工作、无人可借钱、无车或无房、单身/从未结婚）。采用 Cox 比例风险分析。
该队列中 57%为非裔美国人，33%为白人，10%为多种族/其他；19%在 12 个月内再次入院。在调整了哮喘严重程度分类后，非裔美国人再入院的可能性是白人的两倍（风险比：1.98；95%置信区间：1.42 至 2.77）。与白人相比，非裔美国照顾者更有可能报告收入较低、教育程度较低、找工作困难、无人可借钱、无车或无房以及单身/从未结婚（均 P ≤.01）。困难解释了观察到的种族再入院差异的 41%；社会经济地位和困难共同解释了 49%。
非裔美国儿童再入院的可能性是白人儿童的两倍；困难解释了这一差异的 40%以上。其他因素（如污染、烟草暴露、住房质量）可能解释了剩余的差异。有针对性的干预措施可能有助于实现更大的儿童健康公平。
