哮喘联盟

   摘要
   目的：明确单亲家庭是否与儿科哮喘相关性重复医疗使用相关，以及评估可解释该相关性的家庭层面社会心理变量。
   方法：本研究为前瞻性队列研究，分析了526例年龄为1～16岁的哮喘或支气管扩张剂敏感型喘息的住院患儿，患儿看护人自我报道其婚姻状况。报道“单亲”的看护人被认为是高危类别。研究结果为12个月内的重复哮喘相关性医疗使用情况(急诊室(ER)再访或再入院)。首先评估四个社会心理变量(家庭收入、看护人心理压力的风险、家庭儿童与成人的比例以及定期出勤托儿所或第二个家的情况)。
   结果：在本队列研究纳入的所有儿童中，在12个月内40%的儿童因为哮喘再次进入ER或医院。在所有的看护人中，59%自述为单亲。单亲状态与每一个社会心理变量均显著相关。与高收入和低儿童-成人比例家庭中的儿童相比，低收入(p<0.05)和高儿童-成人比例(p<0.05)家庭中的儿童再次进入ER或医院的可能性更大。单亲家庭中的病人重复医疗使用的可能性显著高于双亲家庭中的病人(OR 1.44, 95% CI 1.00-2.07, p<0.05)。校正收入后，单亲家庭与重复医疗的使用无显著性差异。
   结论：12个月的研究结果显示，与双亲家庭儿童相比，收治的单亲家庭哮喘儿童更有可能使用哮喘相关性重复医疗。这在很大程度上是受家庭收入的潜在差异所驱动。

（林江涛 审校）
J Asthma. 2013 Dec 10. [Epub ahead of print]

Single Parent Households and Increased Child Asthma Morbidity.

Moncrief TM, Beck AF, Simmons JM, Huang B, Kahn RS.

ABSTRACT
OBJECTIVES: To characterize whether single parent households are associated with pediatric asthma-related repeat healthcare utilization and to examine family-level psychosocial variables that may explain this relationship.
METHODS: We analyzed a prospective cohort of 526 children aged 1-16 years hospitalized for asthma or bronchodilator-responsive wheezing whose caregivers self-reported their marital status. Those reporting being "single" were considered the at-risk category. The outcome was repeat asthma-related utilization (emergency room (ER) revisit or hospital readmission) within 12 months. We assessed, a priori, four psychosocial variables (household income, caregiver risk of psychological distress, ratio of in-home children to adults, and regular attendance at childcare or a secondary home).
RESULTS: Among all children enrolled in the cohort, 40% returned to the ER or hospital for asthma within 12 months. Of all caregivers, 59% self-identified as single. Single status was significantly associated with each psychosocial variable. Children in households with lower incomes and higher ratios of children to adults were both more likely to return to the ER or hospital than children with higher incomes and lower ratios, respectively (each p<0.05). Patients in single parent households were significantly more likely to reutilize than those in married parent households (OR 1.44, 95% CI 1.00-2.07, p<0.05). When adjusted for income, the relationship between single parent households and reutilization became non-significant.
CONCLUSIONS: Children admitted for asthma from single parent households were more likely to have asthma-related reutilization within 12 months than children from homes with married parents. This was driven, in large part, by underlying differences in household income.

J Asthma. 2013 Dec 10. [Epub ahead of print]