Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
J Invest Dermatol. 2019 Sep;139(9):1906-1913.e1. doi: 10.1016/j.jid.2019.02.024. Epub 2019 Mar 13.
Previous studies indicate racial/ethnic differences in health care utilization for pediatric atopic dermatitis (AD), but do not account for disease severity impact. We sought to examine the relationship between race/ethnicity and health care utilization, both overall and by specific visit type, while accounting for AD control. A longitudinal cohort study of children with AD in the United States was performed to evaluate the association between race/ethnicity and health care utilization for AD. AD control and health care utilization were assessed biannually. Our study included 7,522 children (34.2% white, 54.2% black, and 11.5% Hispanic) who were followed for a median of 4 years (interquartile range 0.9-8.4 years). After adjusting for sociodemographic and other factors, black and Hispanic children were up to nearly threefold more likely than white children to receive medical care for AD across almost all levels of AD control. Black and Hispanic children had higher odds of primary care and emergency visits compared to whites. Black children with poorly controlled AD were significantly less likely to see a dermatologist than white children with similarly poorly controlled AD (odds ratio = 0.74, 95% confidence interval = 0.64-0.85 for limited control; odds ratio = 0.59, 95% confidence interval = 0.47-0.76 for uncontrolled AD). Together, these findings suggest the presence of racial/ethnic disparities in health care utilization for AD.
先前的研究表明，儿科特应性皮炎（AD）的医疗保健利用存在种族/民族差异，但并未考虑疾病严重程度的影响。我们旨在研究种族/民族与医疗保健利用之间的关系，包括总体关系和特定就诊类型的关系，同时考虑 AD 的控制情况。在美国，对患有 AD 的儿童进行了一项纵向队列研究，以评估种族/民族与 AD 的医疗保健利用之间的关联。AD 的控制和医疗保健利用每两年评估一次。我们的研究包括 7522 名儿童（34.2%为白人，54.2%为黑人，11.5%为西班牙裔），他们的中位随访时间为 4 年（四分位距 0.9-8.4 年）。在调整了社会人口统计学和其他因素后，黑人和西班牙裔儿童接受 AD 治疗的可能性是白人儿童的近三倍，几乎在 AD 控制的所有水平上都是如此。与白人儿童相比，黑人和西班牙裔儿童接受初级保健和急诊就诊的可能性更高。与控制良好的 AD 白人儿童相比，控制不佳的 AD 黑人儿童看皮肤科医生的可能性显著降低（轻度控制时的比值比为 0.74，95%置信区间为 0.64-0.85；未控制 AD 时的比值比为 0.59，95%置信区间为 0.47-0.76）。综上所述，这些发现表明 AD 的医疗保健利用存在种族/民族差异。
