背景:尽管特应性疾病和相关的合并症在儿童中普遍存在,对急诊科(ED)探视的种族差异知之甚少。
目的:我们试图研究患有过敏性合并症的儿童在ED探视中的种族差异。
方法:我们对在大型儿科医院就诊的特应性皮炎(AD)患者(<21岁)进行了回顾性研究,食物过敏(FA),哮喘,过敏性鼻炎(AR),和2015年至2019年的嗜酸性粒细胞性食管炎(EoE)。我们使用确定为黑人/非洲裔美国人(AA)和白人/欧洲裔美国人(EA)的患者的ED发作风险比(HR)和复发时间(TTR)确定了无ED发作的可能性。我们评估了潜在的潜在过敏,人口统计学,和基于地点的因素,以及因素之间的潜在相互作用。
结果:共有30,894名患者(38%AA,62%EA)有83,078次ED遭遇(38,378次第一次ED遭遇,和44,700例复发性ED遭遇)在研究期间。在AA和EA儿童中,哮喘和AR在ED中的合并症发生率最高。AA儿童在遇到指数AD和哮喘后表现出更高的HR。我们在AD的ED遭遇中发现了保险类型和种族之间的相互作用,FA,AR,和EoE。在AA儿童中,与那些有商业保险的人相比,那些被医疗补助保险的人表现出更高的HR。相反,在EA儿童中,与他们的商业保险同行相比,那些有医疗补助保险的人表现出更低的HR。不管种族,过敏性合并症增加了所有过敏性疾病的ED发作HR(1.12-1.62)。在5年的随访中,与EA儿童相比,AA儿童的TTR平均差异较短,FA,和哮喘。
结论:确定与特应性疾病相关的ED访视中的疾病特异性种族差异是设计和实施能够公平减少特应合并症儿童急诊护理的干预措施的必要的第一步。
BACKGROUND: Although atopic diseases and associated co-morbidities are prevalent in children, little is known about racial differences in emergency department (
ED) visitation.
OBJECTIVE: We sought to examine racial differences in ED visitation among children with allergic comorbidities.
METHODS: We conducted a retrospective study of patients (<21 years) who visited the
ED at a large pediatric hospital for atopic dermatitis (AD), food allergy (FA), asthma, allergic rhinitis (AR), and eosinophilic esophagitis (EoE) from 2015 to 2019. We determined the probability of ED encounter-free using hazard ratios (HR) and time to recurrence (TTR) of
ED encounter for patients identified as Black/African American (AA) and White/European American (EA). We assessed potentially underlying allergic, demographic, and place-based factors, and potential interactions between factors.
RESULTS: A total of 30,894 patients (38% AA, 62% EA) had 83,078 ED encounters (38,378 first
ED encounters, and 44,700 recurrent
ED encounters) during the study period. Asthma and AR showed the highest rate of comorbidity in
ED encounters in both AA and EA children. AA children exhibited higher HR for encounter following index AD and asthma encounters. We found an interaction between the type of insurance and race in ED encounters for AD, FA, AR, and EoE. In AA children, those insured by Medicaid demonstrated a higher HR for any encounter compared to those with commercial insurance. Conversely, in EA children, those with Medicaid insurance showed a lower HR compared to their commercially insured peers. Regardless of race, allergic comorbidity increased the HR of ED encounter (1.12-1.62) for all allergic diseases. At 5-years follow up, mean differences in TTR were shorter in AA children compared to EA children in AD, FA, and asthma.
CONCLUSIONS: Identification of disease-specific racial disparities in ED visitation related to atopic diseases is a necessary first step toward the design and implementation of interventions capable of equitably reducing emergency care in atopic comorbid children.