社会经济特征是阻塞性肺病健康状况种族差异的主要促成因素：对2007 - 2010年美国国家健康与营养检查调查的分析
Socioeconomic Characteristics Are Major Contributors to Ethnic Differences in Health Status in Obstructive Lung Disease: An Analysis of the National Health and Nutrition Examination Survey 2007-2010.
作者信息
Martinez Carlos H, Mannino David M, Curtis Jeffrey L, Han MeiLan K, Diaz Alejandro A
机构信息
Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI.
Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, KY; Department of Epidemiology, Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, KY.
出版信息
Chest. 2015 Jul;148(1):151-158. doi: 10.1378/chest.14-1814.
BACKGROUND
Understanding ethnic differences in health status (HS) could help in designing culturally appropriate interventions. We hypothesized that racial and ethnic differences exist in HS between non-Hispanic whites and Mexican Americans with obstructive lung disease (OLD) and that these differences are mediated by socioeconomic factors.
METHODS
We analyzed 826 US adults aged ≥ 30 years self-identified as Mexican American or non-Hispanic white with spirometry-confirmed OLD (FEV₁/FVC < 0.7) who participated in the National Health and Nutrition Examination Survey 2007-2010. We assessed associations between Mexican American ethnicity and self-reported HS using logistic regression models adjusted for demographics, smoking status, number of comorbidities, limitations for work, and lung function and tested the contribution of education and health-care access to ethnic differences in HS.
RESULTS
Among Mexican Americans with OLD, worse (fair or poor) HS was more prevalent than among non-Hispanic whites (weighted percentage [SE], 46.6% [5.0] vs 15.2% [1.6]; P < .001). In bivariate analysis, socioeconomic characteristics were associated with lower odds of reporting poor HS (high school graduation: OR, 0.24 [95% CI, 0.10-0.40]; access to health care: OR, 0.50 [95% CI, 0.30-0.80]). In fully adjusted models, a strong association was found between Mexican American ethnicity (vs non-Hispanic white) and fair or poor HS (OR, 7.52; 95% CI, 4.43-12.78; P < .001). Higher education and access to health care contributed to lowering the Mexican American ethnicity odds of fair or poor HS by 47% and 16%, respectively, and together, they contributed 55% to reducing the differences in HS with non-Hispanic whites.
CONCLUSIONS
Mexican Americans with OLD report poorer overall HS than non-Hispanic whites, and education and access to health care are large contributors to the difference.
背景
了解健康状况（HS）中的种族差异有助于设计符合文化背景的干预措施。我们假设，在患有阻塞性肺病（OLD）的非西班牙裔白人和墨西哥裔美国人之间，HS存在种族和民族差异，且这些差异由社会经济因素介导。
方法
我们分析了826名年龄≥30岁、自我认定为墨西哥裔美国人或非西班牙裔白人且经肺功能测定确诊为OLD（FEV₁/FVC < 0.7）的美国成年人，他们参与了2007 - 2010年的国家健康和营养检查调查。我们使用逻辑回归模型评估墨西哥裔美国人种族与自我报告的HS之间的关联，该模型针对人口统计学、吸烟状况、合并症数量、工作限制和肺功能进行了调整，并测试了教育和医疗保健可及性对HS种族差异的影响。
结果
在患有OLD的墨西哥裔美国人中，较差（一般或差）的HS比非西班牙裔白人更为普遍（加权百分比[标准误]，46.6%[5.0]对15.2%[1.6]；P <.001）。在双变量分析中，社会经济特征与报告较差HS的较低几率相关（高中毕业：比值比，0.24[95%置信区间，0.10 - 0.40]；获得医疗保健：比值比，0.50[95%置信区间，0.30 - 0.80]）。在完全调整的模型中，发现墨西哥裔美国人种族（与非西班牙裔白人相比）与一般或差的HS之间存在强关联（比值比，7.52；95%置信区间，4.43 - 12.78；P <.001）。高等教育和获得医疗保健分别使墨西哥裔美国人种族出现一般或差的HS的几率降低了47%和16%，两者共同作用使与非西班牙裔白人在HS方面的差异降低了55%。
结论
患有OLD的墨西哥裔美国人报告的总体HS比非西班牙裔白人差，教育和获得医疗保健是造成这种差异的主要因素。
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