Abstract：
Causes of asthma exacerbation in children have been studied extensively at the individual level, but contributions of neighborhood-level factors are less explored. We test which distinctive residential characteristics produce variation in uncontrolled asthma among pediatric patients. We extracted electronic medical record data from pediatric patients living in Southern California and used multilevel modeling techniques to isolate which neighborhood characteristics drive inequitable asthma control. Above and beyond the individual-level factors known to predict inadequate disease control, neighborhoods with greater concentration of non-Hispanic black residents (odds ratios [OR] = 1.02; 95% confidence interval [CI]: 0.99-1.03; P < .05), higher proportions of female-headed households (OR = 1.01; 95% CI: 0.99-1.01; P < .05), and higher levels of ambient air pollution (OR = 1.05; 95% CI: 1.01-1.10; P < .001) associate with greater odds of asthma exacerbation. The interplay between community characteristics and asthma management during childhood is complex, and place-based initiatives are needed to narrow the gap in asthma exacerbation.
摘要：
儿童哮喘恶化的原因已经在个人层面进行了广泛的研究，但邻里层面因素的贡献研究较少。我们测试了哪些独特的居住特征会在儿科患者中产生不受控制的哮喘的变化。我们从居住在南加州的儿科患者中提取了电子病历数据，并使用多级建模技术来分离出导致哮喘控制不均的邻里特征。超越已知预测疾病控制不足的个体水平因素，非西班牙裔黑人居民更集中的社区(比值比[OR]=1.02；95%置信区间[CI]：0.99-1.03；P<.05)，女性户主家庭比例较高(OR=1.01；95%CI：0.99-1.01；P<.05)，和较高的环境空气污染水平(OR=1.05;95%CI:1.01-1.10;P<.001)与哮喘加重的几率相关。儿童期社区特征和哮喘管理之间的相互作用是复杂的，需要基于地点的举措来缩小哮喘恶化的差距.
