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Role of financial and social hardships in asthma racial disparities

机译：经济和社会困难在哮喘种族差异中的作用

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BACKGROUND AND OBJECTIVES: Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models. METHODS: We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being singleever married) were recorded. Analyses used Cox proportional hazards. RESULTS: The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being singleever married (all P ≤ .01). Hardships explained 41% of the observed racial disparity in readmission; jointly, socioeconomic status and hardship explained 49%. CONCLUSIONS: African American children were twice as likely to be readmitted as white children; hardships explained >40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity.
机译：背景与目的：医疗改革为解决儿童健康差异提供了新的机会。这项研究旨在表征小儿哮喘再入院的种族差异，重点是在未来的患者护理模型中可能解决的困境的潜在解释作用。方法：我们纳入了一项基于人群的前瞻性观察队列研究，纳入了774例1至16岁的儿童，这些儿童因哮喘或支气管扩张剂引起的喘息而入院。结果是重新入院的时间了。记录了孩子的种族，社会经济状况（由低收入和照顾者的教育程度衡量）和困难（照顾者找工作，没有人借钱，没有汽车或房屋，以及单身/从未结婚）。分析使用的Cox比例风险。结果：该队列为57％的非洲裔美国人，33％的白人和10％的多种族/其他。 19％在12个月内重新进入。调整哮喘严重程度分类后，非裔美国人被重新接纳的可能性是白人的两倍（危险比：1.98; 95％置信区间：1.42至2.77）。与白人相比，非裔美国人的照料者更有可能报告较低的收入和受教育程度，难以找到工作，没有人可以借钱，没有汽车或房屋，以及单身/从未结婚（所有P≤.01 ）。困难解释了重新接纳中观察到的种族差异的41％;社会经济地位和困难合起来占49％。结论：非裔美国儿童被重新接纳的可能性是白人儿童的两倍。困难解释了这种差异的40％以上。其他因素（例如，污染，烟草接触，住房质量）可能会解释残留差异。有针对性的干预措施可以帮助实现更大的儿童健康公平。

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