Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
Ann Fam Med. 2022 Mar-Apr;20(2):116-122. doi: 10.1370/afm.2771.
Previous work has shown that asthma-related emergency department (ED) use is greatest among Black and Latine populations, but it is unknown whether health care use for exacerbations differs across settings (outpatient, ED, inpatient) and correlates with use of routine outpatient services. We aimed to measure disparities by race, ethnicity, and language in pediatric acute asthma care using data from US primary care community health centers.
In an observational study using electronic health records from community health centers in 18 states, we compared non-Hispanic Black, English-preferring Latine, Spanish-preferring Latine, and non-Hispanic White children aged 3 to 17 years on visits for clinic-coded asthma exacerbations (2012-2018). We further evaluated asthma-related ED use and inpatient admissions in a subsample of Oregon-Medicaid recipients. Covariate-adjusted odds ratios (ORs) and rate ratios (RRs) were derived using logistic or negative binomial regression analysis with generalized estimating equations.
Among 41,276 children with asthma, Spanish-preferring Latine children had higher odds of clinic visits for asthma exacerbation than non-Hispanic White peers (OR = 1.10; 95% CI, 1.02-1.18). Among the subsample of 6,555 children insured under Oregon-Medicaid, non-Hispanic Black children had higher odds and rates of asthma-related ED use than non-Hispanic White peers (OR = 1.40; 95% CI, 1.04-1.89 and RR = 1.49; 95% CI, 1.09-2.04, respectively). We observed no differences between groups in asthma-related inpatient admissions.
This study is the first to show that patterns of clinic and ED acute-care use differ for non-Hispanic Black and Spanish-preferring Latine children when compared with non-Hispanic White peers. Non-Hispanic Black children had lower use of clinics, whereas Spanish-preferring Latine children had higher use, including for acute exacerbations. These patterns of clinic use were accompanied by higher ED use among Black children. Ensuring adequate care in clinics may be important in mitigating disparities in asthma outcomes..
既往研究表明，在黑人和拉丁裔人群中，与哮喘相关的急诊科（ED）就诊率最高，但尚不清楚在不同环境（门诊、ED、住院）下，加重期的治疗是否存在差异，以及与常规门诊服务的使用是否相关。本研究旨在利用美国初级保健社区健康中心的电子健康记录数据，评估儿科急性哮喘治疗中种族、民族和语言差异。
在一项观察性研究中，我们使用来自 18 个州的社区健康中心的电子健康记录，比较了年龄在 3 至 17 岁之间的非西班牙裔黑人、英语偏好拉丁裔、西班牙语偏好拉丁裔和非西班牙裔白人儿童在因哮喘加重就诊的情况（2012-2018 年）。我们还在俄勒冈州 Medicaid 受保者的亚组中评估了哮喘相关的 ED 使用和住院情况。使用逻辑回归或负二项回归分析（带有广义估计方程）得出校正后的比值比（OR）和率比（RR）。
在 41276 名哮喘儿童中，西班牙语偏好拉丁裔儿童的哮喘加重门诊就诊率高于非西班牙裔白人同龄人（OR=1.10；95%CI，1.02-1.18）。在俄勒冈州 Medicaid 受保的 6555 名儿童亚组中，非西班牙裔黑人儿童哮喘相关 ED 使用的 OR 和 RR 均高于非西班牙裔白人同龄人（OR=1.40；95%CI，1.04-1.89 和 RR=1.49；95%CI，1.09-2.04）。各组之间在哮喘相关住院方面无差异。
本研究首次表明，与非西班牙裔白人群体相比，非西班牙裔黑人和西班牙语偏好拉丁裔儿童的门诊和 ED 急性治疗模式存在差异。非西班牙裔黑人儿童的门诊就诊率较低，而西班牙语偏好拉丁裔儿童的就诊率较高，包括急性加重期。这些门诊使用模式伴随着黑人儿童 ED 使用率的增加。确保在门诊提供充足的护理可能对减轻哮喘结局的差异至关重要。
