Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA.
College of Medicine, Alfaisal University, 7746 Ibrahim Alziady St., Alwurud District, 12253 2499, Riyadh, Saudi Arabia.
Glob Health Res Policy. 2021 May 27;6(1):17. doi: 10.1186/s41256-021-00199-y.
Asthma disproportionately affects minority and low-income children. We examined asthma prevalence, management and outcomes, focusing on race/ethnicity and acculturation of parents (particularly English language proficiency).
This cross-sectional, correlational analysis used a de-identified population-based survey, the California Health Interview Survey, for years 2001-2015. Survey-weighted analysis with SAS 9.4 was used to determine asthma prevalence among children 1 to 11 years of age. Descriptive analysis was conducted, adjusting for survey design and combination of multiple years of data. The Pearson test, using design-based F values was used to determine statistically significant differences between those having/not having a doctor diagnosis of asthma. Multivariable logistic regression, with jackknife approach to obtain confidence intervals, was used to examine associations of child and parental characteristics with asthma prevalence, management, and outcomes.
The 61,625 completed surveys represented an estimated annual population of 5.7 million children, of which 12.9 % had asthma. There were significant (p < 0.001) differences by age, gender, race, and language proficiency, with higher asthma prevalence for children 6 to 11 years of age (15.5 %), males (15.3 %), African Americans (19.5 %), and parents speaking English very well (14.1 %). Compared to children whose parents spoke English very well, those whose parents spoke English not well or not at all were less likely to achieve optimal asthma management, i.e. to have received a management plan from doctor (OR 0.30; 95 % Confidence Interval 0.20-0.46)), to be currently taking medication to control asthma (OR 0.52; 95 % CI 0.36-0.74)), or to be not confident in ability to control asthma (OR 3.10; 95 % CI 1.49-6.42). Children whose parents spoke English fairly well rather than very well had worse outcomes, i.e. were more likely to have an emergency room visit in past 12 months (OR 1.92; 95 % CI 1.03-3.61) and were more likely to miss school due to asthma in past 12 months (OR 0.71; 1.01-2.94).
Socio-demographics had a limited role in explaining differences across a handful of asthma management and outcome measures in California. Parental English language proficiency had the most consistent influence, underscoring the need for culturally and linguistically competent care.
哮喘在少数族裔和低收入儿童中发病率较高。我们研究了哮喘的流行率、管理和结果，重点关注父母的种族/族裔和文化适应（尤其是英语熟练程度）。
本横断面、相关性分析使用了一个去识别的基于人群的调查，即加利福尼亚健康访谈调查，时间范围为 2001 年至 2015 年。使用 SAS 9.4 进行了调查加权分析，以确定 1 至 11 岁儿童的哮喘流行率。进行了描述性分析，根据调查设计和多年数据的组合进行了调整。使用 Pearson 检验（使用基于设计的 F 值）确定了那些有/没有医生诊断哮喘的儿童之间的统计学显著差异。使用 Jackknife 方法获得置信区间的多变量逻辑回归用于检查儿童和父母特征与哮喘流行率、管理和结果之间的关联。
61625 份完成的调查代表了估计的每年 570 万儿童的人口，其中 12.9%患有哮喘。年龄、性别、种族和语言熟练程度存在显著差异（p<0.001），6 至 11 岁儿童（15.5%）、男性（15.3%）、非裔美国人（19.5%）和英语非常流利的父母（14.1%）的哮喘患病率较高。与父母英语非常流利的儿童相比，父母英语不太流利或根本不会说英语的儿童不太可能实现最佳哮喘管理，即从医生那里获得管理计划（OR 0.30；95%置信区间 0.20-0.46）），目前正在服用药物控制哮喘（OR 0.52；95%CI 0.36-0.74）），或对控制哮喘的能力没有信心（OR 3.10；95%CI 1.49-6.42）。父母英语说得相当好而不是非常好的儿童的预后更差，即过去 12 个月因哮喘急诊就诊的可能性更高（OR 1.92；95%CI 1.03-3.61），过去 12 个月因哮喘缺课的可能性更高（OR 0.71；95%CI 1.01-2.94）。
社会人口统计学在解释加利福尼亚州少数几种哮喘管理和结果衡量标准方面的差异方面作用有限。父母的英语熟练程度影响最大，这突显了需要进行文化和语言能力方面的护理。
