哮喘联盟

   摘要
   基本原理：吸入性糖皮质激素（ICS）已经广泛应用于哮喘管理中。先前的研究显示，哮喘患者的ICS使用可能由于种族差异而不同。
   目的：本研究旨在评估西班牙裔和非西班牙裔白种哮喘患者ICS处方的比例是否存在差异，以确定哮喘患者ICS处方的独立预测因素。
   方法：利用2009年美国医疗费用委员会调查数据对比如下纳入标准的哮喘患者ICS处方：西班牙裔和非西班牙裔白种人，年龄大于4岁，确诊为哮喘。采用多因素logistic回归分析确定种族及其它有效因素对ICS处方的影响。
   结果：本研究共纳入1,469例哮喘患者，与符合纳入标准的14,401,069例美国哮喘患者的加权样本一致，其中16.1%为西班牙裔，59.5%为女性，平均年龄为39.9岁。在非西班牙裔白种哮喘患者中，39.7%（35%为儿童，41%为成人）有ICS处方，而在西班牙裔中只有22.2%（23.9%为儿童，21.2%为成人），P<0.001。在多因素回归模型中，独立于其他因素，年龄≥18岁的西班牙裔患者较非西班牙裔白种患者ICS处方几率低43% （OR值为0.6，95%可信区间：0.3－0.9）。而西班牙裔和非西班牙裔白种哮喘儿童（年龄4－17岁）间ICS处方情况则无显著性差异。
   结论：在日益增长的少数民族群体中，西班牙裔和非西班牙裔白种成人哮喘患者间ICS处方的差异可能导致哮喘管理不佳，更高的哮喘急性发作率，以及更高的医疗费用。西班牙裔和非西班牙裔白种哮喘患者间ICS处方的差异和潜在差距需要进一步的调查研究以更好的理解该差距的原因，以及他们对美国医疗保健负担的影响，和可以减少这些差距的干预措施。
 

（杨冬 审校）
 Ann Am Thorac Soc. 2014 Dec 4. [Epub ahead of print]


 

Assessing Disparities in the Receipt of Inhaled Corticosteroid Prescriptions for Asthma by Hispanic and Non-Hispanic White Patients.
 

Kharat AA1, Borrego ME, Raisch DW, Roberts MH, Blanchette CM, Petersen H.
 

ABSTRACT
RATIONALE: Inhaled corticosteroids (ICS) are widely used in the management of asthma. Prior research suggests that access to ICS among patients with asthma may vary by ethnicity.
OBJECTIVES: Study objectives were to determine if there is a difference in the proportion of Hispanic and non-Hispanic white patients with asthma in the receipt of an ICS prescription and to determine independent predictors for the receipt of an ICS prescription for asthma.
METHODS: The 2009 US Medical Expenditure Panel Survey data were utilized to compare the receipt of ICS prescription among patients with asthma with the following inclusion criteria: Hispanic and non-Hispanic white ethnicity, age over 4 years, diagnostic codes for asthma. Multiple logistic regression was used to determine the influence of race/ethnicity and other significant factors on the receipt of an ICS prescription.
RESULTS: There were 1,469 patients with asthma, corresponding to a weighted sample of 14,401,069 US patients with asthma who met the inclusion criteria, represented by 16.1% Hispanic, 59.5% female, and mean age of 39.9 years. Among non-Hispanic white patients with asthma, 39.7% (35% children and 41% adults) had a receipt of an ICS prescription compared to 22.2% of Hispanic patients (23.9% children and 21.2% adults), P<0.001. In the multiple regression model, Hispanic patients aged ≥18 years had 43% lower odds (OR, 0.6; 95% CI. 0.3 to 0.9) of having a receipt of an ICS prescription compared to non-Hispanic white patients, independent of other factors. There was no significant difference in receipt of an ICS prescription between Hispanic and non-Hispanic white children with asthma (ages 4 to 17 years).
CONCLUSION: The disparity in the receipt of ICS prescription between Hispanic and non-Hispanic white adult patients with asthma could result in suboptimal asthma management, a higher rate of exacerbations, and higher healthcare costs in this growing minority population. The differences and potential disparities in the receipt of an ICS prescription between Hispanic and non-Hispanic white patients with asthma warrant further investigation to better understand the reasons for such disparities, along with their impact on the US healthcare burden, and interventions that can be undertaken to reduce these disparities.
 

Ann Am Thorac Soc. 2014 Dec 4. [Epub ahead of print]