哮喘及相关疾病患者开始使用生物制剂时间与种族和民族有关，而不仅仅与保险有关
2024/08/28
摘要
背景：哮喘治疗中存在不公平现象。
目的：评价不同种族保险对哮喘及相关疾病患者使用生物疗法的影响。
方法：我们使用来自马萨诸塞州波士顿一家大型医疗保健系统的2011-2020年电子健康记录数据进行了逆概率加权(IPW)分析。我们评估了在批准适应症的处方一年内未开始使用omalizumab或mepolizumab治疗的几率。
结果：我们确定了1132名符合研究标准的患者。其中27%的患者有公共保险，12% 属于历史边缘群体 (HMG)。四分之一的患者没有开始使用处方生物制剂。在哮喘患者中，与非HMG患者相比，无论保险类型如何，HMG患者在用药前的病情恶化率都较高。在HMG哮喘患者中，与拥有公共保险的患者相比，拥有私人保险的患者不开始治疗的可能性较低（OR:0.67; 95% CI:0.56-0.79）。在患有哮喘的非HMG患者中，私人投保者和公共投保者未开始处方生物制剂治疗的比例相似（OR：1.02；95% CI：0.95-1.09）。与非HMG相比，HMG患者未开始治疗的几率更高（OR：1.16；95% CI：1.03-1.31），但私人投保的HMG和非HMG并无显著差异（OR：0.99；95% CI：0.91-1.07）。
结论：属于HMG的公费参保者尽管哮喘较严重，但在处方开具时使用生物制剂的可能性较低，而属于其他群体的参保者则不存在不平等现象。
Race & ethnicity, not just insurance, is associated with biologics initiation in asthma and related conditions
Ayobami Akenroye, Christopher Hvisdas, Jessica Stern, John W Jackson, Margee Louisias
Abstract
BACKGRUND:There are pre-existing inequities in asthma care.
OBJECTIVES: To evaluate effect modification by race of the effect of insurance on biologic therapy use in patients with asthma and related diseases.
METHODS:We conducted inverse probability weighted (IPW) analyses using electronic health records data from 2011-2020 from a large healthcare system in Boston, MA. We evaluated the odds of not initiating omalizumab or mepolizumab therapy within one year of prescription for an approved indication.
RESULTS:We identified 1,132 individuals who met study criteria. Twenty-seven percent of these patients had public insurance and 12% belonged to a historically marginalized group (HMG). A quarter of patients did not initiate the prescribed biologic. Among patients with asthma, individuals belonging to HMG had higher exacerbation rates in the period before initiation compared to non-HMG individuals, regardless of insurance type. Among HMG patients with asthma, those with private insurance were less likely to not initiate therapy compared to those with public insurance, (Odds Ratio, (OR) 0.67, and 95% Confidence Interval, [CI] 0.56 - 0.79). Among non-HMG with asthma, privately insured and publicly insured individuals had similar rates of not initiating the prescribed biologic (OR: 1.02; 95% CI: 0.95 -1.09). Among those publicly insured with asthma, HMGs had higher odds of not initiating therapy compared to non-HMGs (OR 1.16; 95% CI 1.03 - 1.31), but privately-insured HMG and non-HMG did not differ significantly (OR: 0.99; 95% CI: 0.91 - 1.07).
CONCLUSION:Publicly insured individuals belonging to HMG are less likely to initiate biologics when prescribed despite having more severe asthma, while there are no inequities by insurance in individuals belonging to other groups.
背景：哮喘治疗中存在不公平现象。
目的：评价不同种族保险对哮喘及相关疾病患者使用生物疗法的影响。
方法：我们使用来自马萨诸塞州波士顿一家大型医疗保健系统的2011-2020年电子健康记录数据进行了逆概率加权(IPW)分析。我们评估了在批准适应症的处方一年内未开始使用omalizumab或mepolizumab治疗的几率。
结果：我们确定了1132名符合研究标准的患者。其中27%的患者有公共保险，12% 属于历史边缘群体 (HMG)。四分之一的患者没有开始使用处方生物制剂。在哮喘患者中，与非HMG患者相比，无论保险类型如何，HMG患者在用药前的病情恶化率都较高。在HMG哮喘患者中，与拥有公共保险的患者相比，拥有私人保险的患者不开始治疗的可能性较低（OR:0.67; 95% CI:0.56-0.79）。在患有哮喘的非HMG患者中，私人投保者和公共投保者未开始处方生物制剂治疗的比例相似（OR：1.02；95% CI：0.95-1.09）。与非HMG相比，HMG患者未开始治疗的几率更高（OR：1.16；95% CI：1.03-1.31），但私人投保的HMG和非HMG并无显著差异（OR：0.99；95% CI：0.91-1.07）。
结论：属于HMG的公费参保者尽管哮喘较严重，但在处方开具时使用生物制剂的可能性较低，而属于其他群体的参保者则不存在不平等现象。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（J Allergy Clin lmmunol. 2024 Aug 6:S0091-6749(24)00780-2. DOI:10.1080/07853890.2023.2258926.）
（J Allergy Clin lmmunol. 2024 Aug 6:S0091-6749(24)00780-2. DOI:10.1080/07853890.2023.2258926.）
Race & ethnicity, not just insurance, is associated with biologics initiation in asthma and related conditions
Ayobami Akenroye, Christopher Hvisdas, Jessica Stern, John W Jackson, Margee Louisias
Abstract
BACKGRUND:There are pre-existing inequities in asthma care.
OBJECTIVES: To evaluate effect modification by race of the effect of insurance on biologic therapy use in patients with asthma and related diseases.
METHODS:We conducted inverse probability weighted (IPW) analyses using electronic health records data from 2011-2020 from a large healthcare system in Boston, MA. We evaluated the odds of not initiating omalizumab or mepolizumab therapy within one year of prescription for an approved indication.
RESULTS:We identified 1,132 individuals who met study criteria. Twenty-seven percent of these patients had public insurance and 12% belonged to a historically marginalized group (HMG). A quarter of patients did not initiate the prescribed biologic. Among patients with asthma, individuals belonging to HMG had higher exacerbation rates in the period before initiation compared to non-HMG individuals, regardless of insurance type. Among HMG patients with asthma, those with private insurance were less likely to not initiate therapy compared to those with public insurance, (Odds Ratio, (OR) 0.67, and 95% Confidence Interval, [CI] 0.56 - 0.79). Among non-HMG with asthma, privately insured and publicly insured individuals had similar rates of not initiating the prescribed biologic (OR: 1.02; 95% CI: 0.95 -1.09). Among those publicly insured with asthma, HMGs had higher odds of not initiating therapy compared to non-HMGs (OR 1.16; 95% CI 1.03 - 1.31), but privately-insured HMG and non-HMG did not differ significantly (OR: 0.99; 95% CI: 0.91 - 1.07).
CONCLUSION:Publicly insured individuals belonging to HMG are less likely to initiate biologics when prescribed despite having more severe asthma, while there are no inequities by insurance in individuals belonging to other groups.
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气候和环境因素对儿童和青少年哮喘的影响： 基于时空分析证据的系统综述
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成人哮喘患者带状疱疹的总体负担：系统回顾和荟萃分析
