上呼吸道病毒是否导致哮喘急诊就诊中的种族和种族差异？
2023/02/01
摘要
背景：按种族和民族划分，儿童哮喘相关急诊就诊率存在显著差异。实施2019冠状病毒病（COVID-19）预防措施后，与哮喘相关的ED就诊率大幅下降。这种下降归因于上呼吸道病毒的循环减少，而上呼吸道病毒是儿童哮喘恶化的常见诱因。
研究目的：为了更好地了解呼吸道病毒对ED就诊率种族和族裔差异的影响，我们调查了ED就诊率的降低是否对患有哮喘的黑人、拉丁裔和白人儿童有同等影响。
方法：与哮喘相关的ED就诊是从德克萨斯州特拉维斯县戴尔儿童医疗中心的电子病历中提取的。哮喘儿童的ED就诊率是根据种族/民族得出的。按年份（2019-2021年）和季节估计发病率比率（IRR）和95% CI。
结果：2019年春季，教育部对黑人儿童和白人儿童以及拉美裔儿童和白人孩子的访问IRR分别为6.67（95% CI=4.92-9.05）和2.10（95% CI=1.57-2.80）。2020年春季，当实施感染预防措施时，相应的内部收益率分别下降至1.73（95% CI=0.90-3.32）和0.68（95% CI=0.38-1.23）。
结论：ED就诊差异的显著减少表明，在非流行期，呼吸道病毒导致黑人和拉丁美洲哮喘儿童与哮喘相关的ED就诊负担过重。尽管需要进一步的调查来验证这一假设，但我们的发现提出了一个问题，即患有哮喘的黑人和拉美裔儿童是否更容易受到上呼吸道病毒感染。
Do upper respiratory viruses contribute to racial and ethnic disparities in emergency department visits for asthma?
Bhavnani, D., Wilkinson, M., Zárate, R. A., Balcer-Whaley, S., Katz, D. S. W., Rathouz, P. J., & Matsui, E. C. (2022)
Abstract
BACKGROUND:There are marked disparities in asthma-related emergency department (ED) visit rates among children by race and ethnicity. Following the implementation of coronavirus disease 2019 (COVID-19) prevention measures, asthma-related ED visits rates declined substantially. The decline has been attributed to the reduced circulation of upper respiratory viruses, a common trigger of asthma exacerbations in children.
OBJECTIVES:To better understand the contribution of respiratory viruses to racial and ethnic disparities in ED visit rates, we investigated whether the reduction in ED visit rates affected Black, Latinx, and White children with asthma equally.
METHODS:Asthma-related ED visits were extracted from electronic medical records at Dell Children's Medical Center in Travis County, Texas. ED visit rates among children with asthma were derived by race/ethnicity. Incidence rate ratios (IRRs) and 95% CIs were estimated by year (2019-2021) and season.
RESULTS:In spring 2019, the ED visit IRRs comparing Black children with White children and Latinx children with White children were 6.67 (95% CI = 4.92-9.05) and 2.10 (95% CI = 1.57-2.80), respectively. In spring 2020, when infection prevention measures were implemented, the corresponding IRRs decreased to 1.73 (95% CI = 0.90-3.32) and 0.68 (95% CI = 0.38-1.23), respectively.
CONCLUSION:The striking reduction of disparities in ED visits suggests that during nonpandemic periods, respiratory viruses contribute to the excess burden of asthma-related ED visits among Black and Latinx children with asthma. Although further investigation is needed to test this hypothesis, our findings raise the question of whether Black and Latinx children with asthma are more vulnerable to upper respiratory viral infections.
背景：按种族和民族划分，儿童哮喘相关急诊就诊率存在显著差异。实施2019冠状病毒病（COVID-19）预防措施后，与哮喘相关的ED就诊率大幅下降。这种下降归因于上呼吸道病毒的循环减少，而上呼吸道病毒是儿童哮喘恶化的常见诱因。
研究目的：为了更好地了解呼吸道病毒对ED就诊率种族和族裔差异的影响，我们调查了ED就诊率的降低是否对患有哮喘的黑人、拉丁裔和白人儿童有同等影响。
方法：与哮喘相关的ED就诊是从德克萨斯州特拉维斯县戴尔儿童医疗中心的电子病历中提取的。哮喘儿童的ED就诊率是根据种族/民族得出的。按年份（2019-2021年）和季节估计发病率比率（IRR）和95% CI。
结果：2019年春季，教育部对黑人儿童和白人儿童以及拉美裔儿童和白人孩子的访问IRR分别为6.67（95% CI=4.92-9.05）和2.10（95% CI=1.57-2.80）。2020年春季，当实施感染预防措施时，相应的内部收益率分别下降至1.73（95% CI=0.90-3.32）和0.68（95% CI=0.38-1.23）。
结论：ED就诊差异的显著减少表明，在非流行期，呼吸道病毒导致黑人和拉丁美洲哮喘儿童与哮喘相关的ED就诊负担过重。尽管需要进一步的调查来验证这一假设，但我们的发现提出了一个问题，即患有哮喘的黑人和拉美裔儿童是否更容易受到上呼吸道病毒感染。
(中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2022 Nov 16; DOI: 10.1016/j.jaci.2022.10.031)
(J Allergy Clin Immunol. 2022 Nov 16; DOI: 10.1016/j.jaci.2022.10.031)
Do upper respiratory viruses contribute to racial and ethnic disparities in emergency department visits for asthma?
Bhavnani, D., Wilkinson, M., Zárate, R. A., Balcer-Whaley, S., Katz, D. S. W., Rathouz, P. J., & Matsui, E. C. (2022)
Abstract
BACKGROUND:There are marked disparities in asthma-related emergency department (ED) visit rates among children by race and ethnicity. Following the implementation of coronavirus disease 2019 (COVID-19) prevention measures, asthma-related ED visits rates declined substantially. The decline has been attributed to the reduced circulation of upper respiratory viruses, a common trigger of asthma exacerbations in children.
OBJECTIVES:To better understand the contribution of respiratory viruses to racial and ethnic disparities in ED visit rates, we investigated whether the reduction in ED visit rates affected Black, Latinx, and White children with asthma equally.
METHODS:Asthma-related ED visits were extracted from electronic medical records at Dell Children's Medical Center in Travis County, Texas. ED visit rates among children with asthma were derived by race/ethnicity. Incidence rate ratios (IRRs) and 95% CIs were estimated by year (2019-2021) and season.
RESULTS:In spring 2019, the ED visit IRRs comparing Black children with White children and Latinx children with White children were 6.67 (95% CI = 4.92-9.05) and 2.10 (95% CI = 1.57-2.80), respectively. In spring 2020, when infection prevention measures were implemented, the corresponding IRRs decreased to 1.73 (95% CI = 0.90-3.32) and 0.68 (95% CI = 0.38-1.23), respectively.
CONCLUSION:The striking reduction of disparities in ED visits suggests that during nonpandemic periods, respiratory viruses contribute to the excess burden of asthma-related ED visits among Black and Latinx children with asthma. Although further investigation is needed to test this hypothesis, our findings raise the question of whether Black and Latinx children with asthma are more vulnerable to upper respiratory viral infections.
