期刊
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
卷 143, 期 6, 页码 2052-2061出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2018.11.022
关键词
Asthma control; asthma exacerbation; racial disparities; health care use; propensity scoring; inverse probability of treatment weighting
资金
- National Heart, Lung, and Blood Institute [U10 HL109086, U10 HL109146, U10 HL109152, U10 HL109164, U10 HL109168, U10 HL109172, U10 HL109250, U10 HL109257]
- National Institutes of Health National Center for Advancing Translational Sciences [UL1 TR001420, UL1 TR000427, UL1 TR001102, UL1 TR002378]
Background: Despite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared with white patients. Objective: We sought to determine associations between black and white patients and asthma-related health care use, accounting for complex relationships. Methods: This study was completed as part of the National Heart, Lung, and Blood Institute's Severe Asthma Research Program, a prospective observational cohort. Between November 2012 and February 2015, it enrolled 579 participants 6 years and older with 1 year of observation time and complete data. Inverse probability of treatment weighting was used to balance racial groups with respect to community and family socioeconomic variables and environmental exposure variables. The primary outcome was emergency department (ED) use for asthma. Secondary outcomes included inhaled corticosteroid use, outpatient physician's office visits for asthma, and asthma-related hospitalization. Results: Black patients had greater odds of ED use over 1 year (odds ratio, 2.19; 95% CI, 1.43-3.35) but also differed in the majority (>50%) of baseline variables measured. After statistical balancing of the racial groups, the difference between black andwhite patients with respect to ED use no longer reached the level of significance. Instead, in secondary analyses black patients were less likely to see an outpatient physician for asthma management (adjusted odds ratio, 0.57; 95% CI, 0.38-0.85). Conclusions: The disparity in ED use was eliminated after consideration of multiple variables. Social and environmental policies and interventions tailored to black populations with a high burden of asthma are critical to reduction (or elimination) of these disparities.
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