健康素养与社会经济状态对哮喘差异的影响
2012/02/29
方法:对芝加哥2004年至2007年353名年龄为18~40岁的持续哮喘患者进行队列研究。基础水平对健康素养、SES以及包括疾病控制、生活质量、急诊就医和住院在内的哮喘转归进行评价,哮喘转归在2年内每3个月通过电话记录。采用多变量模型评价哮喘转归的种族差异和健康素养及SES对这些估计值的影响。
结果:与白人相比,非洲裔成人的所有哮喘转归明显较差(p <0.05),拉丁裔美国人的生活质量明显较差(β = -0.47; 95%CI = -0.79, -0.14; p =0.01),且哮喘控制也较差(RR= 0.63; 95% CI = 0.41, 0.98; p =0.04)。SES的不同能部分解释上述差异。健康素养能解释拉丁裔人和白人间生活质量差异的20.2%,但非洲裔人和白人之间住院率之间的差异仍然存在(RR = 2.97; 95% CI = 1.09, 8.12, p=0.03)。
结论:健康素养可能是解释哮喘差异的被忽视的因素。因此,在综合干预措施中,应该包括针对较低健康素养患者的教育和咨询。
J Asthma. 2012 Jan 25. [Epub ahead of print]
Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University , Chicago, IL , USA.
OBJECTIVE:Racial/ethnic disparities have been well documented in asthma. While socioeconomic status (SES) has been repeatedly implicated as a root cause, the role of limited health literacy has not been extensively studied. The purpose of this study was to examine the independent contributions of SES and health literacy in explaining asthma disparities.
METHODS:A cohort study was conducted in a Chicago-based sample of 353 adults aged 18-40 years with persistent asthma from 2004 to 2007. Health literacy, SES, and asthma outcomes including disease control, quality of life, emergency department visits, and hospitalizations were assessed in person at baseline, and asthma outcomes were measured every 3 months for 2 years by phone. Multivariate models were used to assess racial/ethnic disparities in asthma outcomes and the effect of health literacy and SES on these estimates.
RESULTS:Compared with White participants, African American adults fared significantly worse in all asthma outcomes (p < .05) and Latino participants had lower quality of life (β = -0.47; 95% confidence interval [CI] = -0.79, -0.14; p = .01) and worse asthma control (risk ratio [RR] = 0.63; 95% CI = 0.41, 0.98; p = .04). Differences in SES partially explained these disparities. Health literacy explained an additional 20.2% of differences in quality of life between Latinos and Whites, but differences in hospitalization rates between African American and White adults remained (RR = 2.97; 95% CI = 1.09, 8.12, p = .03).
CONCLUSIONS:Health literacy appears to be an overlooked factor explaining racial and ethnic disparities in asthma. Evidence-based low literacy strategies for patient education and counseling should be included in comprehensive interventions.
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通过社区健康工作者模型改善非洲裔美国儿童的哮喘管理:来自芝加哥的预试验结果
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哮喘儿童急诊就诊时,城市初级医疗机构医生有关启动哮喘控制治疗的观点