Neighborhood Deprivation and Crime on Asthma Exacerbations and Utilization in Mild Adult Asthma.

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2024-11-01 Epub Date: 2024-08-13 DOI:10.1016/j.jaip.2024.08.014

Stanley Xu, Eric J Puttock, Robert S Zeiger, William M Vollmer, Michael Schatz, William W Crawford, Fagen Xie, Wansu Chen

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引用次数: 0

Abstract

Background: Social determinants of health have a significant impact on asthma outcomes, and factors such as income level and neighborhood environment have crucial roles.

Objective: This study aimed to assess the impact of the Neighborhood Deprivation Index (NDI) and Total Crime Index (TCI) on acute asthma exacerbation (AAE) and asthma-related emergency department and urgent care (ED/UC) visits in adults with mild asthma.

Methods: This retrospective cohort study used administrative data from Kaiser Permanente Southern California among 198,873 adult patients with mild asthma between January 1, 2013 and December 31, 2018. We employed robust Poisson regression models, adjusted for age and sex, to investigate the associations of NDI and TCI with AAE and asthma-related ED/UC visits. Data analysis included subgroup assessments by race and ethnicity and body mass index categories to explore potential disparities in asthma outcomes.

Results: Among the cohort, 12,906 patients (6.5%) experienced AAE in 1 year, and Black patients had the highest AAE percentage (7.1%). Higher NDI quintiles were associated with increased AAE risk (adjusted risk ratio = 1.11-1.27), with similar trends across body mass index categories and race or ethnicity, except for Black patients. The TCI showed weaker associations with AAE. Regarding ED/UC visits, 5.0% had such visits within 1 year. Higher NDI quintiles were associated with higher ED/UC visit risk (adjusted risk ratio = 1.23-1.75) whereas TCI associations were weaker.

Conclusion: Addressing socioeconomic disparities, as indicated by NDI, may be crucial in mitigating asthma exacerbations and reducing health care use, highlighting the importance of incorporating social determinants into asthma management strategies even in patients with mild asthma.

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邻里贫困和犯罪对轻度成人哮喘患者哮喘恶化和用药的影响。

背景：健康的社会决定因素（SDOH）对哮喘的治疗效果有重大影响，其中收入水平和邻里环境等因素起着至关重要的作用：本研究旨在评估邻里贫困指数（NDI）和总犯罪指数（TCI）对轻度哮喘成人急性哮喘加重（AAE）和哮喘相关急诊及紧急护理（ED/UC）就诊的影响：这项回顾性队列研究利用了南加州凯泽医疗集团（Kaiser Permanente Southern California）在 2013 年 1 月 1 日至 2018 年 12 月 31 日期间对 198873 名轻度成人哮喘患者的管理数据。采用经年龄和性别调整的稳健泊松回归模型来研究 NDI 和 TCI 与 AAE 和哮喘相关 ED/UC 就诊的关系。数据分析包括按种族、民族和体重指数类别进行的亚组评估，以探讨哮喘结果的潜在差异：在队列中，12906 名患者（6.5%）在一年内经历了 AAE，其中黑人患者的 AAE 百分比最高（7.1%）。NDI五分位数越高，AAE风险越高（aRR：1.11-1.27），除黑人患者外，不同体重指数类别和种族或民族的趋势相似。TCI与AAE的相关性较弱。关于急诊室/急诊室就诊，5.0%的患者在一年内就诊。较高的NDI五分位数与较高的ED/UC就诊风险相关（aRRs：1.23-1.75），而TCI相关性较弱：NDI显示，解决社会经济差异可能对缓解哮喘恶化和减少医疗保健使用至关重要，这凸显了将社会决定因素纳入哮喘管理策略的重要性，即使对轻度哮喘患者也是如此。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.