Gottlieb D J, Beiser A S, O'Connor G T
Department of Medicine, Boston University School of Medicine, USA.
Chest. 1995 Jul;108(1):28-35. doi: 10.1378/chest.108.1.28.
Hospitalization rates for asthma in New York City are highest in poor urban neighborhoods, although the reasons for this are unknown. We performed a small area analysis of asthma hospitalization rates in Boston, to determine whether this pattern of asthma hospitalization also obtained in a medium-sized city and to identify characteristics of neighborhoods with high hospitalization rates, including the relative use of inhaled anti-inflammatory medication. Zip codes were used to define 22 small areas within Boston. The number of asthma hospitalizations for residents of each area in 1992 was obtained from the Codman Research Group. Population and demographic characteristics of each area were obtained from the 1990 US Census. Estimates of inhaled asthma medications (beta-agonists, steroids, and cromolyn) dispensed in each area in 1992 were obtained from IMS America. Asthma hospitalization rates for each of the six areas with the highest rates (5.3 to 9.8 per 1,000 persons) were significantly greater than the city-wide average of 4.2 hospitalizations per thousand persons (p < 0.001 for each comparison). Asthma hospitalization rate was positively correlated with poverty rate and with the proportion of nonwhite residents and inversely correlated with income and educational attainment. Asthma hospitalization rate was inversely correlated with the ratio of inhaled anti-inflammatory to beta-agonist medication use (r = -0.55, p = 0.008). We conclude that asthma hospitalization rates in Boston are highest in poor inner city neighborhoods, and that these high rates affect both genders and all age groups. Underuse of inhaled anti-inflammatory medication may be one of the many factors that contributes to this excess hospitalization.
纽约市贫困城区的哮喘住院率最高，不过其原因尚不清楚。我们对波士顿的哮喘住院率进行了小区域分析，以确定这种哮喘住院模式在一个中等规模城市是否也存在，并找出住院率高的社区特征，包括吸入性抗炎药物的相对使用情况。邮政编码被用来定义波士顿市内的22个小区域。1992年各区域居民的哮喘住院人数来自科德曼研究小组。各区域的人口和人口统计学特征来自1990年美国人口普查。1992年各区域吸入性哮喘药物（β-激动剂、类固醇和色甘酸钠）的配药量来自美国IMS公司。哮喘住院率最高的六个区域（每千人中有5.3至9.8例）中每个区域的哮喘住院率均显著高于全市每千人4.2例的平均住院率（每次比较p<0.001）。哮喘住院率与贫困率、非白人居民比例呈正相关，与收入和教育程度呈负相关。哮喘住院率与吸入性抗炎药物与β-激动剂药物使用比例呈负相关（r=-0.55，p=0.008）。我们得出结论，波士顿贫困市中心社区的哮喘住院率最高，而且这些高住院率影响到男女两性和所有年龄组。吸入性抗炎药物使用不足可能是导致这种住院率过高的众多因素之一。
