Correa-Agudelo Esteban, Ding Lili, Beck Andrew F, Kahn Robert S, Mersha Tesfaye B
Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Division 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 Pract. 2024 Oct;12(10):2826-2837.e10. doi: 10.1016/j.jaip.2024.07.009. Epub 2024 Jul 17.
Although atopic diseases and associated comorbidities are prevalent in children, little is known about racial differences in emergency department (ED) visitation.
We sought to examine racial differences in ED visitation among children with allergic comorbidities.
We conducted a retrospective study of patients (<21 years) who visited the ED at a large pediatric hospital for atopic dermatitis (AD), food allergy (FA), asthma, allergic rhinitis (AR), and eosinophilic esophagitis (EoE) from 2015 to 2019. We determined the probability of ED encounter-free survival time using hazard ratios (HRs) and time to recurrence (TTR) of ED encounter for patients identified as Black/African American (AA) and White/European American (EA). We assessed potentially underlying allergic, demographic, and place-based factors and potential interactions between factors.
A total of 30,894 patients (38% AA and 62% EA) had 83,078 ED encounters (38,378 first ED encounters and 44,700 recurrent ED encounters) during the study period. Asthma and AR showed the highest rate of comorbidity in ED encounters in both AA and EA children. AA children exhibited a higher HR for encounter following index AD and asthma encounters. We found an interaction between the type of insurance and race in ED encounters for AD, FA, AR, and EoE. In AA children, those insured by Medicaid demonstrated a higher HR for any encounter than those with commercial insurance. Conversely, in EA children, those with Medicaid insurance showed a lower HR than their commercially insured peers. Regardless of race, allergic comorbidity increased the HR of ED encounter (1.12-1.62) for all allergic diseases. At 5-year follow-up, mean differences in TTR were shorter in AA children than EA children in AD, FA, and asthma.
Identification of disease-specific racial disparities in ED visitation related to atopic diseases is a necessary first step toward the design and implementation of interventions capable of equitably reducing emergency care in atopic comorbid children.
尽管特应性疾病及相关合并症在儿童中很常见，但关于急诊科就诊的种族差异知之甚少。
我们试图研究患有过敏性合并症的儿童在急诊科就诊的种族差异。
我们对2015年至2019年在一家大型儿科医院急诊科就诊的特应性皮炎（AD）、食物过敏（FA）、哮喘、过敏性鼻炎（AR）和嗜酸性食管炎（EoE）患者（<21岁）进行了一项回顾性研究。我们使用风险比（HR）和急诊科再就诊时间（TTR）确定了被确定为黑人/非裔美国人（AA）和白人/欧洲裔美国人（EA）的患者无急诊科就诊生存时间的概率。我们评估了潜在的潜在过敏、人口统计学和基于地点的因素以及因素之间的潜在相互作用。
在研究期间，共有30894名患者（38%为AA，62%为EA）进行了83078次急诊科就诊（38378次首次急诊科就诊和44700次再发急诊科就诊）。哮喘和AR在AA和EA儿童的急诊科就诊中合并症发生率最高。AA儿童在首次AD和哮喘就诊后再就诊的HR较高。我们发现，在AD、FA、AR和EoE的急诊科就诊中，保险类型和种族之间存在相互作用。在AA儿童中，由医疗补助保险的儿童比有商业保险的儿童任何就诊的HR都高。相反，在EA儿童中，有医疗补助保险的儿童比有商业保险的同龄人HR低。无论种族如何，过敏性合并症都会增加所有过敏性疾病急诊科就诊的HR（1.12 - 1.62）。在5年随访中，AD、FA和哮喘的AA儿童TTR的平均差异比EA儿童短。
识别与特应性疾病相关的急诊科就诊中特定疾病的种族差异是设计和实施能够公平减少特应性合并症儿童急诊护理的干预措施的必要第一步。
