Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY, 10032, USA.
Psychology Department, Dickinson College, P.O. Box 1773, Carlisle, PA, 17013, USA.
J Urban Health. 2019 Apr;96(2):252-261. doi: 10.1007/s11524-018-00340-2.
Undiagnosed asthma adds to the burden of asthma and is an especially significant public health concern among urban adolescents. While much is known about individual-level demographic and neighborhood-level factors that characterize those with diagnosed asthma, limited data exist regarding these factors and undiagnosed asthma. This observational study evaluated associations between undiagnosed asthma and individual and neighborhood factors among a large cohort of urban adolescents. We analyzed data from 10,295 New York City adolescents who reported on asthma symptoms and diagnosis; a subset (n = 6220) provided addresses that we were able to geocode into US Census tracts. Multivariable regression models estimated associations between undiagnosed asthma status and individual-level variables. Hierarchical linear modeling estimated associations between undiagnosed asthma status and neighborhood-level variables. Undiagnosed asthma prevalence was 20.2%. Females had higher odds of being undiagnosed (adjusted odds ratio (AOR) = 1.25; 95% confidence interval (CI) = 1.13-1.37). Compared to White, non-Hispanic adolescents, Asian-Americans had higher risk of being undiagnosed (AOR = 1.41; 95% CI = 1.01-1.95); Latinos (AOR = 0.67; 95% CI = 0.45-0.83); and African-Americans/Blacks (AOR = 0.66; 95% CI = 0.52-0.87) had lower risk; Latinos and African-Americans/Blacks did not differ significantly. Living in a neighborhood with a lower concentration of Latinos relative to White non-Latinos was associated with lower risk of being undiagnosed (AOR = 0.66; CI = 0.43-0.95). Living in a neighborhood with health care provider shortages was associated with lower risk of being undiagnosed (AOR = 0.80; 95% CI =0.69-0.93). Public health campaigns to educate adolescents and their caregivers about undiagnosed asthma, as well as education for health care providers to screen adolescent patients for asthma, are warranted.
未确诊的哮喘会加重哮喘的负担，尤其对城市青少年而言是一个重大的公共卫生问题。虽然人们对诊断出患有哮喘的个体和社区的特征有了很多了解，但关于这些因素与未确诊哮喘的关系的数据却很有限。本观察性研究评估了大量城市青少年中未确诊哮喘与个体和社区因素之间的关联。我们分析了报告哮喘症状和诊断的 10295 名纽约市青少年的数据；其中一组（n=6220）提供了可以将地址地理编码为美国人口普查区的地址。多变量回归模型估计了未确诊哮喘状况与个体水平变量之间的关联。分层线性模型估计了未确诊哮喘状况与社区水平变量之间的关联。未确诊哮喘的患病率为 20.2%。女性未确诊的可能性更高（调整后的优势比 (AOR) =1.25；95%置信区间 (CI) =1.13-1.37）。与白人非西班牙裔青少年相比，亚裔美国人未确诊的风险更高（AOR =1.41；95% CI =1.01-1.95）；拉丁裔（AOR =0.67；95% CI =0.45-0.83）和非裔美国人/黑人（AOR =0.66；95% CI =0.52-0.87）的风险较低；拉丁裔和非裔美国人/黑人之间没有显著差异。与白人非拉丁裔相比，生活在拉丁裔浓度较低的社区与未确诊的风险较低相关（AOR =0.66；CI =0.43-0.95）。生活在医疗服务提供者短缺的社区与未确诊的风险较低相关（AOR =0.80；95% CI =0.69-0.93）。需要开展公共卫生运动，向青少年及其照顾者宣传未确诊的哮喘，并教育医疗保健提供者对青少年患者进行哮喘筛查。
