Kattan M, Mitchell H, Eggleston P, Gergen P, Crain E, Redline S, Weiss K, Evans R, Kaslow R, Kercsmar C, Leickly F, Malveaux F, Wedner H J
Mount Sinai School of Medicine, New York, New York, USA.
Pediatr Pulmonol. 1997 Oct;24(4):253-62. doi: 10.1002/(sici)1099-0496(199710)24:4<253::aid-ppul4>3.0.co;2-l.
Asthma morbidity has increased dramatically in the past decade, especially among poor and minority children in the inner cities. The National Cooperative Inner-City Asthma Study (NCICAS) is a multicenter study designed to determine factors that contribute to asthma morbidity in children in the inner cities. A total of 1,528 children with asthma, ages 4 to 9 years old, were enrolled in a broad-based epidemiologic investigation of factors which were thought to be related to asthma morbidity. Baseline assessment included morbidity, allergy evaluation, adherence and access to care, home visits, and pulmonary function. Interval assessments were conducted at 3, 6, and 9 months after the baseline evaluations. Over the one-year period, 83% of the children had no hospitalizations and 3.6% had two or more. The children averaged 3 to 3.5 days of wheeze for each of the four two-week recall periods. The pattern of skin test sensitivity differed from other populations in that positive reactions to cockroach were higher (35%) and positive reactions to house dust mite were lower (31%). Caretakers reported smoking in 39% of households of children with asthma, and cotinine/creatinine ratios exceeded 30 ng/mg in 48% of the sample. High exposure (> 40 ppb) to nitrogen dioxide was found in 24% of homes. Although the majority of children had insurance coverage, 53% of study participants found it difficult to get follow-up asthma care. The data demonstrate that symptoms are frequent but do not result in hospitalization in the majority of children. These data indicate a number of areas which are potential contributors to the asthma morbidity in this population, such as environmental factors, lack of access to care, and adherence to treatment. Interventions to reduce asthma morbidity are more likely to be successful if they address the many different asthma risks found in the inner cities.
在过去十年中，哮喘发病率急剧上升，尤其是在市中心的贫困儿童和少数族裔儿童中。全国城市内部哮喘合作研究（NCICAS）是一项多中心研究，旨在确定导致城市内部儿童哮喘发病的因素。共有1528名4至9岁的哮喘儿童参加了一项广泛的流行病学调查，调查那些被认为与哮喘发病有关的因素。基线评估包括发病率、过敏评估、治疗依从性和就医机会、家访以及肺功能。在基线评估后的3个月、6个月和9个月进行定期评估。在这一年期间，83%的儿童没有住院，3.6%的儿童住院两次或更多次。在四个为期两周的回忆期内，儿童平均每次有3至3.5天喘息。皮肤试验敏感性模式与其他人群不同，对蟑螂的阳性反应较高（35%），对屋尘螨的阳性反应较低（31%）。照顾者报告说，39%的哮喘儿童家庭中有吸烟现象，48%的样本中可替宁/肌酐比值超过30 ng/mg。24%的家庭中发现二氧化氮暴露量高（>40 ppb）。尽管大多数儿童有保险，但53%的研究参与者发现很难获得哮喘后续治疗。数据表明，症状很常见，但大多数儿童不会因此住院。这些数据表明了一些可能导致该人群哮喘发病的领域，如环境因素、就医困难和治疗依从性。如果干预措施能够解决城市内部发现的许多不同的哮喘风险，那么降低哮喘发病率的干预措施更有可能取得成功。
