Divisions of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
Divisions of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
J Allergy Clin Immunol. 2022 Dec;150(6):1427-1436.e5. doi: 10.1016/j.jaci.2022.07.024. Epub 2022 Aug 12.
Racial disparities in childhood asthma outcomes result from a complex interplay of individual- and neighborhood-level factors.
We sought to examine racial disparities in asthma-related emergency department (ED) visits between African American (AA) and European American (EA) children.
This is a retrospective study of patients younger than 18 years who visited the ED at Cincinnati Children's for asthma from 2009 to 2018. The outcome was number of ED visits during a year. We assessed 11 social, economic, and environmental variables. Mediation and mixed-effects analyses were used to assess relationships between race, mediators, and number of ED visits.
A total of 31,114 children (46.1% AA, 53.9% EA) had 186,779 asthma-related ED visits. AA children had more visits per year than EA children (2.23 vs 2.15; P < .001). Medicaid insurance was associated with a 7% increase in rate of ED visits compared with commercial insurance (1.07; 95% CI, 1.03-1.1). Neighborhood socioeconomic deprivation was associated with an increased rate of ED visits in AA but not in EA children. Area-level particulate matter with diameter less than 2.5 μm, pollen, and outdoor mold were associated with an increased rate of ED visits for both AA and EA children (all P < .001). Associations between race and number of ED visits were mediated by insurance, area-level deprivation, particulate matter with diameter less than 2.5 μm, and outdoor mold (all P < .001), altogether accounting for 55% of the effect of race on ED visits. Race was not associated with number of ED visits (P = .796) after accounting for mediators.
Racial disparities in asthma-related ED visits are mediated by social, economic, and environmental factors, which may be amenable to interventions aimed at improving outcomes and eliminating inequities.
儿童哮喘结局的种族差异是个体和社区层面因素复杂相互作用的结果。
我们旨在研究非裔美国儿童（AA）和欧洲裔美国儿童（EA）之间哮喘相关急诊就诊的种族差异。
这是一项回顾性研究，纳入了 2009 年至 2018 年期间因哮喘在辛辛那提儿童医院急诊科就诊的年龄小于 18 岁的患者。结局为一年内急诊就诊次数。我们评估了 11 个社会、经济和环境变量。采用中介和混合效应分析来评估种族、中介因素和急诊就诊次数之间的关系。
共有 31114 名儿童（46.1%为 AA，53.9%为 EA）有 186779 次哮喘相关急诊就诊。AA 儿童每年就诊次数多于 EA 儿童（2.23 次比 2.15 次；P<0.001）。与商业保险相比，医疗补助保险与急诊就诊次数增加 7%相关（1.07；95%CI，1.03-1.1）。社区社会经济剥夺与 AA 儿童而不是 EA 儿童急诊就诊次数增加相关。区域水平的细颗粒物（直径小于 2.5μm）、花粉和室外霉菌与 AA 和 EA 儿童急诊就诊次数增加相关（均 P<0.001）。种族与急诊就诊次数之间的关联通过保险、区域水平剥夺、细颗粒物（直径小于 2.5μm）和室外霉菌来介导（均 P<0.001），这些因素共同解释了种族对急诊就诊次数影响的 55%。在考虑到中介因素后，种族与急诊就诊次数之间无关联（P=0.796）。
哮喘相关急诊就诊的种族差异是由社会、经济和环境因素介导的，这些因素可能易于采取干预措施，以改善结局并消除不平等。
