哮喘患者的危险因素和预后评估
2009/06/24
目的：在亚利桑那州医疗救助机构的哮喘患者中研究与医疗保健利用情况相关的危险因素。
方法：研究数据来源于2002年1月1日～2003年12月31日亚利桑那州医疗救助机构相关资料。入选标准包括诊断为哮喘的患者（ICD9-CM 493.XX），年龄5～62岁，新近使用激素吸入（ICS）治疗，ICS+长效β激动剂治疗或白三烯受体拮抗剂。研究因素包括年龄、地理位置（城市/乡村）、种族（白种人、非西班牙裔黑人、西班牙人及其他人种）、用药连贯性、前期短效β-受体激动剂治疗（SABA）以及共患疾病。医疗保健利用情况通过检测SABA的使用情况、基于就诊获得的哮喘加重情况、哮喘相关医疗支出和医疗保健总费用等因素进行评价。分别采用负二项分布、logistic 回归、普通线性模型γ家族、log-link分析医疗保健的利用情况。
结果：3013名患者满足本研究入选/排除标准，平均年龄24.7±13.7岁。城市居民哮喘加重的可能性较乡村居民增加55%（OR为0.45, 95% CI: 0.27-0.78）。年龄（18～62岁）是SABA的使用量（发生率比-IRR 1.22, 95% CI: 1.06-1.41）和哮喘急性加重（OR为2.07, 95% CI: 1.28-3.38）的较好的预测因子。预测平均的哮喘支出费用在5～17岁人群为530美元 (95% CI: $461-608)；18～39岁人群为702美元 (95% CI：$600-822)；40～62岁人群为583美元 (95%: CI $468-726)。男性哮喘加重的可能性较女性低46%（OR为0.54, 95% CI: 0.31-0.94）。种族之间哮喘加重未见显著性差异。白种人（$591, 95% CI: $509-686）、黑种人（$638, 95% CI: $499-815）或西班牙人（$535, 95% CI: $466-614）之间，预测的哮喘相关支出未见统计学差异。
结论：上述分析结果显示，与乡村哮喘患者相比，城市患者哮喘相关就诊次数增加，但两者在哮喘相关支出上未见差异，这表明乡村患者哮喘加重支出较多或更加严重。与5～18岁人群相比，18～62岁哮喘患者哮喘相关急诊就诊/住院次数较多。与5～17岁及 40～62患者相比，18～39岁患者哮喘相关支出较多。种族不是哮喘预后及哮喘相关支出的重要预测因子。
（苏楠 审校）
Smith K, et al. J Asthma. 2009 Apr;46(3):234-237
Evaluation of risk factors and health outcomes among persons with asthma.
OBJECTIVE: To examine risk factors associated with healthcare utilization in Arizona Medicaid patients with asthma.
METHODS: Data were obtained from Arizona Medicaid between 1/1/2002 and 12/31/2003. Inclusion criteria consisted of persons with an asthma diagnosis (ICD9-CM 493.XX), 5 to 62 years of age; and were new users of inhaled-corticosteroids (ICS), combination ICS+long-acting beta-agonist, or leukotriene-modifiers. Factors examined included age, geographic location (urban/rural), race/ethnicity (White, non-Hispanic Black, Hispanic, other), medication adherence, pre-period short-acting beta-agonist use (SABA), and co-morbidities. Utilization measures examined included SABA use; exacerbations measured by hospital visits; and asthma-related and total healthcare costs. Analyses for utilization measures were performed using negative binomial, logistic regression, and generalized linear modeling gamma-family, log-link, respectively.
RESULTS: A total of 3,013 subjects met inclusion/exclusion criteria and had a mean age (+/-SD) of 24.7 +/-13.7 years. Urban residents were 55% more likely to have an exacerbation than rural residents (odds ratio-OR 0.45, 95%CI: 0.27-0.78). Age (years 18 to 62) was a significant predictor for SABA use (incidence rate ratio-IRR 1.22, 95% CI: 1.06-1.41); and exacerbations (OR 2.07, 95% CI: 1.28-3.38). Mean predicted asthma cost was $530 (95% CI: $461-608) for ages 5 to 17, $702 (95% CI $600-822) for ages 18 to 39), and $583 (95% CI $468-726) for ages 40 to 62. Males were 46% less likely to have an exacerbation than females (OR 0.54, 95% CI: 0.31-0.94). Exacerbations were not different between race/ethnicity categories. Predicted mean asthma-related costs were not different between Whites ($591, 95% CI: $509-686), Blacks ($638, 95% CI: $499-815), or Hispanics ($535, 95% CI: $466-614).
CONCLUSIONS: Results of these analyses found urban areas had higher rates of asthma-related hospital visits compared to rural counties, but no difference in asthma-costs between urban and rural areas which may suggest rural exacerbations may be more costly or severe. Persons with asthma aged 18 to 62 had higher rates of asthma-related emergency-room visits/hospitalizations than those aged 5 to 18. Persons 18 to 39 years of age had higher costs than person 5 to 17 or 40 to 62. Race/ethnicity in this population was not a significant predictor of outcomes or asthma-related costs.
上一篇：
使用哮喘吸入治疗装置之前，呼出气体体积是否重要?（诊断与监测）
下一篇：
sGaw、FEF(25-75)和FEV1在乙酰甲胆碱吸入激发反应阴性的患者中对哮喘发生的预测价值
