Lozano P, Connell F A, Koepsell T D
Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
JAMA. 1995 Aug 9;274(6):469-73.
To determine whether African-American children with asthma use more emergency department (ED) and inpatient medical services and fewer preventive services than white children with similar insurance coverage and family income.
Historical cohort study during Medicaid claims data.
Aid to Families With Dependent Children enrollees aged 3 through 17 years in Seattle-Tacoma, Wash, metropolitan area.
All 576 African-American children and 1369 white children receiving services for asthma between June 1988 and December 1992.
Utilization of asthma services (ED, impatient, office visits, and pharmacy) and well-child services and associated Medicaid reimbursements.
African-American children were more likely than white children to make ED visits or to be hospitalized for asthma; adjusted odds ratios (ORs) were 1.70 (95% confidence interval [Cl], 1.34 to 2.15) and 1.42 (95% Cl, 1.03 to 1.96), respectively. African-American children were less likely to have made an office visit for asthma; the adjusted OR was 0.48 (95% Cl, 0.26 to 0.85). The two groups were similarly likely to have filled a prescription for an asthma medication and to have made a well-child visit. Per capita payments for asthma services were 24% higher for African-American children: $436 vs $350 per child-year.
Higher use of ED and inpatient services for asthma among African-American children using Medicaid (compared with white children) cannot be fully explained by poverty or inadequate health insurance. Furthermore, these children appear to make disproportionately few office visits for asthma, suggesting suboptimal use of preventive services for asthma. In contrast, the comparable use of well-child visits in the two groups suggests the problem may not be in access to care in general, but there may be specific problems in the successful management of chronic diseases such as asthma among African-American children.
确定与具有相似保险覆盖范围和家庭收入的白人儿童相比，患哮喘的非裔美国儿童是否使用更多的急诊科（ED）和住院医疗服务，而使用的预防服务更少。
基于医疗补助索赔数据的历史性队列研究。
华盛顿州西雅图 - 塔科马大都市地区领取抚养子女家庭援助的3至17岁儿童。
1988年6月至1992年12月期间所有576名接受哮喘治疗服务的非裔美国儿童和1369名白人儿童。
哮喘服务（急诊科、住院、门诊就诊和药房）及儿童健康服务的使用情况以及相关的医疗补助报销情况。
非裔美国儿童因哮喘就诊于急诊科或住院的可能性高于白人儿童；校正后的优势比（OR）分别为1.70（95%置信区间[Cl]，1.34至2.15）和1.42（95%Cl，1.03至1.96）。非裔美国儿童因哮喘进行门诊就诊的可能性较小；校正后的OR为0.48（95%Cl，0.26至0.85）。两组使用哮喘药物处方和进行儿童健康检查的可能性相似。非裔美国儿童哮喘服务的人均支付费用高出24%：每名儿童每年436美元，而白人儿童为350美元。
使用医疗补助的非裔美国儿童（与白人儿童相比）对哮喘的急诊科和住院服务使用更多，这不能完全用贫困或医疗保险不足来解释。此外，这些儿童因哮喘进行的门诊就诊次数明显过少，表明哮喘预防服务的利用欠佳。相比之下，两组儿童健康检查的使用情况相当，这表明问题可能并非普遍存在于获得医疗服务方面，而是在非裔美国儿童中成功管理哮喘等慢性病可能存在特定问题。
