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Jones CJ, Paudyal P, West RM, Mansur AH, Jay N, Makwana N, Baker S, Krishna MT. Burden of allergic disease among ethnic minority groups in high-income countries. Clin Exp Allergy 2022; 52:604-615. [PMID: 35306712 PMCID: PMC9324921 DOI: 10.1111/cea.14131] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/19/2022]
Abstract
The COVID‐19 pandemic raised acute awareness regarding inequities and inequalities and poor clinical outcomes amongst ethnic minority groups. Studies carried out in North America, the UK and Australia have shown a relatively high burden of asthma and allergies amongst ethnic minority groups. The precise reasons underpinning the high disease burden are not well understood, but it is likely that this involves complex gene–environment interaction, behavioural and cultural elements. Poor clinical outcomes have been related to multiple factors including access to health care, engagement with healthcare professionals and concordance with advice which are affected by deprivation, literacy, cultural norms and health beliefs. It is unclear at present if allergic conditions are intrinsically more severe amongst patients from ethnic minority groups. Most evidence shaping our understanding of disease pathogenesis and clinical management is biased towards data generated from white population resident in high‐income countries. In conjunction with standards of care, it is prudent that a multi‐pronged approach towards provision of composite, culturally tailored, supportive interventions targeting demographic variables at the individual level is needed, but this requires further research and validation. In this narrative review, we provide an overview of epidemiology, sensitization patterns, poor clinical outcomes and possible factors underpinning these observations and highlight priority areas for research.
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Affiliation(s)
- Christina J Jones
- School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Priyamvada Paudyal
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, Brighton, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Adel H Mansur
- Birmingham Regional Severe Asthma Service, University Hospitals Birmingham NHS Foundation Trust, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Nicola Jay
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Nick Makwana
- Department of Child Health, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | | | - Mamidipudi T Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Lakhanpaul M, Culley L, Robertson N, Alexander EC, Bird D, Hudson N, Johal N, McFeeters M, Hamlyn-Williams C, Manikam L, Boo YY, Lakhanpaul M, Johnson MRD. A structured collaborative approach to intervention design using a modified intervention mapping approach: a case study using the Management and Interventions for Asthma (MIA) project for South Asian children. BMC Med Res Methodol 2020; 20:271. [PMID: 33138784 PMCID: PMC7607819 DOI: 10.1186/s12874-020-01148-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To describe how using a combined approach of community-based participatory research and intervention mapping principles could inform the development of a tailored complex intervention to improve management of asthma for South Asian (SA) children; Management and Interventions for Asthma (MIA) study. METHODS A qualitative study using interviews, focus groups, workshops, and modified intervention mapping procedures to develop an intervention planning framework in an urban community setting in Leicester, UK. The modified form of intervention mapping (IM) included: systematic evidence synthesis; community study; families and healthcare professionals study; and development of potential collaborative intervention strategies. Participants in the community study were 63 SA community members and 12 key informants; in-depth semi-structured interviews involved 30 SA families, 14 White British (WB) families and 37 Healthcare Professionals (HCPs) treating SA children living with asthma; prioritisation workshops involved 145 SA, 6 WB and 37 HCP participants; 30 participants in finalisation workshops. RESULTS Two key principles were utilised throughout the development of the intervention; community-based participatory research (CBPR) principles and intervention mapping (IM) procedures. The CBPR approach allowed close engagement with stakeholders and generated valuable knowledge to inform intervention development. It accounted for diverse perceptions and experiences with regard to asthma and recognised the priorities of patients and their families/caregivers for service improvement. The 'ACT on Asthma' programme was devised, comprising four arms of an intervention strategy: education and training, clinical support, advice centre and raising awareness, to be co-ordinated by a central team. CONCLUSIONS The modified IM principles utilised in this study were systematic and informed by theory. The combined IM and participatory approach could be considered when tailoring interventions for other clinical problems within diverse communities. The IM approach to intervention development was however resource intensive. Working in meaningful collaboration with minority communities requires specific resources and a culturally competent methodology.
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Affiliation(s)
- Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK. .,Whittington Health NHS Trust, London, UK.
| | - Lorraine Culley
- School of Applied Social Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
| | - Noelle Robertson
- Clinical Psychology, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Lancaster Road, Leicester, LE1 7HA, UK
| | - Emma C Alexander
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, King's College Hospital, London, SE5 9RS, UK.,Aceso Global Health Consultants Ltd., 3 Abbey Terrace, London, SE2 9EY, UK
| | - Deborah Bird
- Child Development Team, Ealing Services for Children with Additional Needs, West London NHS Trust, Carmelita House, 21-22 The Mall, Ealing, W5 2PJ, UK
| | - Nicky Hudson
- School of Applied Social Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
| | | | - Melanie McFeeters
- Specialised Commissioning, NHS England and NHS Improvement, Midlands Region, Fosse House, 6 Smith Way, Grove Park, Enderby, Leicester, LE19 1SX, UK
| | - Charlotte Hamlyn-Williams
- Center for Health Services and Clinical Research, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
| | - Logan Manikam
- Aceso Global Health Consultants Ltd., 3 Abbey Terrace, London, SE2 9EY, UK.,UCL Institute of Epidemiology & Healthcare, 1 - 19 Torrington Place, London, WC1E 7HB, UK
| | - Yebeen Ysabelle Boo
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK.,Aceso Global Health Consultants Ltd., 3 Abbey Terrace, London, SE2 9EY, UK.,Nuffield Department of Population Health, University of Oxford Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Maya Lakhanpaul
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Mark R D Johnson
- Faculty of Health and Life Sciences, Mary Seacole Research Centre, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
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Ahmed S, Steed L, Harris K, Taylor SJC, Pinnock H. Interventions to enhance the adoption of asthma self-management behaviour in the South Asian and African American population: a systematic review. NPJ Prim Care Respir Med 2018; 28:5. [PMID: 29449558 PMCID: PMC5814446 DOI: 10.1038/s41533-017-0070-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 11/09/2022] Open
Abstract
South Asian and other minority communities suffer poorer asthma outcomes, have a higher rate of unscheduled care and benefit less from most existing self-management interventions when compared to the majority population. Possible reasons for these differences include failure to implement asthma self-management strategies, or that strategies implemented were inappropriate for their needs; alternatively, they may relate to the minority and/or lower socioeconomic status of these populations. We aimed to synthesise evidence from randomised controlled trials for asthma self-management in South Asian and Black populations from different sociocultural contexts, and identify barriers and facilitators to implementing self-management. We systematically searched eight electronic databases, and research registers, and manually searched relevant journals and reference lists of reviews. Seventeen trials met the inclusion criteria and were analysed narratively. We found two culturally targeted interventions compared to fifteen culturally modified interventions. Interventions used diverse self-management strategies; education formed a central component. Interventions in South Asian and African-American minority communities were less effective than interventions delivered in indigenous populations in South Asia, though the latter trials were at higher risk of bias. Education, with continuous professional support, was common to most interventions. Facilitators to asthma self-management included: ensuring culturally/linguistically appropriate education, adapting to learning styles, addressing daily stressors/social support and generic self-management strategies. In conclusion, when developing and evaluating self-management interventions aimed at different cultures, the influence of sociocultural contexts (including whether patients are from a minority or indigenous population) can be important for the conceptualisation of culture and customisation of self-management strategies.
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Affiliation(s)
- Salina Ahmed
- Asthma UK Centre for Applied Research, Blizard Institue Queen Mary University London, London, UK
| | - Liz Steed
- Asthma UK Centre for Applied Research, Blizard Institue Queen Mary University London, London, UK.
| | - Katherine Harris
- Asthma UK Centre for Applied Research, Blizard Institue Queen Mary University London, London, UK
| | - Stephanie J C Taylor
- Asthma UK Centre for Applied Research, Blizard Institue Queen Mary University London, London, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London. NPJ Prim Care Respir Med 2016; 26:16049. [PMID: 27537194 PMCID: PMC4989925 DOI: 10.1038/npjpcrm.2016.49] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/08/2016] [Accepted: 06/17/2016] [Indexed: 12/27/2022] Open
Abstract
Inappropriate prescribing in primary care was implicated in nearly half of asthma deaths reviewed in the UK’s recent National Review of Asthma Deaths. Using anonymised EMIS-Web data for 139 ethnically diverse general practices (total population 942,511) extracted from the North and East London Commissioning Support Unit, which holds hospital Secondary Uses Services (SUS)–linked data, we examined the prevalence of over-prescribing of short-acting β2-agonist inhalers (SABA), under-prescribing of inhaled corticosteroid (ICS) inhalers and solo prescribing of long-acting β2-agonists (LABA) to assess the risk of hospitalisation for people with asthma for 1 year ending August 2015. In a total asthma population of 35,864, multivariate analyses in adults showed that the risk of admission increased with greater prescription of SABA inhalers above a baseline of 1–3 (4–12 SABA: odds ratio (OR) 1.71; 95% confidence interval (CI) 1.20–2.46, ⩾13 SABA: OR 3.22; 95% CI 2.04–5.07) with increasing British Thoracic Society step (Step 3: OR 2.90; 95% CI 1.79–4.69, Step 4/5: OR 9.42; 95% CI 5.27–16.84), and among Black (OR 2.30; 95% CI 1.64–3.23) and south Asian adult populations (OR 1.83; 95% CI 1.36–2.47). Results in children were similar, but risk of hospitalisation was not related to ethnic group. There is a progressive risk of hospital admission associated with the prescription of more than three SABA inhalers a year. Adults (but not children) from Black and South Asian groups are at an increased risk of admission. Further work is needed to target care for these at-risk groups.
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Griffiths M, Goldring S, Griffiths C, Shaheen SO, Martineau A, Cross L, Robinson S, Warner JO, Devine A, Boyle RJ. Effects of Pre-Natal Vitamin D Supplementation with Partial Correction of Vitamin D Deficiency on Early Life Healthcare Utilisation: A Randomised Controlled Trial. PLoS One 2015; 10:e0145303. [PMID: 26698303 PMCID: PMC4689556 DOI: 10.1371/journal.pone.0145303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 12/02/2015] [Indexed: 01/02/2023] Open
Abstract
Background Some observational studies have suggested that higher prenatal Vitamin D intake may be associated with improved health outcomes in childhood. However there have been mixed results in this area with some negative studies, especially for effects on atopic and respiratory outcomes. We examined the effect of prenatal Vitamin D on healthcare utilisation in the first three years of life. Methods In an ethnically stratified randomised controlled trial conducted at St Mary’s Hospital London, 180 women at 27 weeks gestation were allocated to no Vitamin D, 800 IU ergocalciferol daily until delivery, or a single oral bolus of 200,000 IU cholecalciferol. Participants were randomised in blocks of 15 using computer-generated numbers and investigators were blinded to group assignment. Supplementation increased maternal and cord blood 25(OH) vitamin D concentrations, but levels remained lower than current recommendations. Primary health economic outcome was overall cost of unscheduled healthcare utilisation in the first three years of life as documented in the child’s electronic health record. Secondary outcomes included cost attributable to: primary and secondary healthcare visits, respiratory and atopic complaints, cost in years 1, 2 and 3 of life and cost and frequency of prescribed medication. All costs were calculated as pounds sterling. Differences between groups were analysed using unpaired t-test or Mann-Whitney U test, and analysis of variance for adjusted analyses. Results We assessed 99/180 (55%) complete electronic health records, control (n = 31), daily (n = 36) and bolus (n = 32). We found no difference in total healthcare utilisation costs between the control and daily (mean difference in costs in pounds sterling 1.02, 95%CI -1.60, 1.65; adjusted 1.07, 95%CI -1.62, 1.86) or control and bolus groups (mean difference -1.58, 95%CI -2.63, 1.06; adjusted –1.40, 95%CI -2.45, 1.24). There were no adverse effects of supplementation reported during the trial. Conclusions We found no evidence that prenatal vitamin D supplementation from 27 weeks gestation to delivery, at doses which failed to completely correct maternal vitamin D deficiency, influence overall healthcare utilisation in children in the first 3 years. Trial Registration Controlled-Trials.com ISRCTN68645785
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Affiliation(s)
- Megan Griffiths
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Stephen Goldring
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Seif O. Shaheen
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Adrian Martineau
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Louise Cross
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Stephen Robinson
- Department of Endocrinology, Imperial College London, London, United Kingdom
| | - John O. Warner
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Angela Devine
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Robert J. Boyle
- Department of Paediatrics, Imperial College London, London, United Kingdom
- * E-mail:
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Cantarero-Arévalo L, Perez Vicente R, Juarez SP, Merlo J. Ethnic differences in asthma treatment among Swedish adolescents: A multilevel analysis of individual heterogeneity. Scand J Public Health 2015; 44:184-94. [PMID: 26553248 DOI: 10.1177/1403494815614749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/15/2022]
Abstract
AIMS Adolescents with immigrant or ethnic minority background suffering from asthma receive on average less appropriate anti-asthmatic medication (AAM) than the majority population. However, those findings are based on analyses of differences between group averages which prevents our understanding of individual heterogeneity around the averages. Taking into account individual socioeconomic factors and medical needs, we performed multilevel analysis in order to evaluate if maternal country of birth (MCOB) accurately identifies adolescents with inappropriate AAM use. METHODS Using the Swedish Medical Birth Register, we identified all singleton children born between 1988 and 1991 who were residing in the country until they turned 17 and had complete information on the study variables. We applied a two-level multilevel logistic regression analysis with 62 MCOBs at the second and 755,894 children at the first level. Adjusting for socioeconomic and medical factors using a risk score, and including the socioeconomic characteristics of the MCOBs, we obtained both measures of association (odds ratio (OR)) and measures of variance (Intra-class correlation (ICC)). RESULTS Comparing with adolescents born from Swedish mothers, all other children had a lower AAM use, especially those whose mothers were from upper-middle- and low-income countries (OR = 0.47, 95% confidence interval: 0.35-0.61). However, the ICC was low (i.e., ICC ≈ 3%) for both preventive and relief AAM. CONCLUSIONS MCOB was associated to adolescent use of AAM. However, the small ICC indicates that MCOB is an inaccurate categorization for identifying inappropriate use of AAM among Swedish adolescents.
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Affiliation(s)
- Lourdes Cantarero-Arévalo
- Faculty of Health and Medical Sciences, Department of Pharmacy, Section for Social and Clinical Pharmacy, University of Copenhagen, Denmark Faculty of Medicine, Unit for Social Epidemiology, Lund University, Malmö, Sweden
| | - Raquel Perez Vicente
- Faculty of Medicine, Unit for Social Epidemiology, Lund University, Malmö, Sweden
| | - Sol Pia Juarez
- Faculty of Medicine, Unit for Social Epidemiology, Lund University, Malmö, Sweden Centrum for Economic Demography, Lund, Sweden
| | - Juan Merlo
- Faculty of Medicine, Unit for Social Epidemiology, Lund University, Malmö, Sweden
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Lakhanpaul M, Bird D, Manikam L, Culley L, Perkins G, Hudson N, Wilson J, Johnson M. A systematic review of explanatory factors of barriers and facilitators to improving asthma management in South Asian children. BMC Public Health 2014; 14:403. [PMID: 24767303 PMCID: PMC4032170 DOI: 10.1186/1471-2458-14-403] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 04/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Asian children with asthma are less likely to receive prescriptions and more likely to suffer uncontrolled symptoms and acute asthma admissions compared with White British children. Understanding barriers are therefore vital in addressing health inequalities. We undertook a systematic review identifying explanatory factors for barriers and facilitators to asthma management in South Asian children. South Asians were defined as individuals of Indian, Pakistani or Bangladeshi descent. METHODS Data Sources - Medline, HMIC, EMBASE, ASSIA, Web of Science, BNI, CINAHL, PsycINFO, OpenSIGLE, CRD, Scopus, NHS Evidence, Cochrane Library, Campbell Collaboration, RCPCH, ATS, ERS, Asthma UK, Google Scholar & Asthma Guidelines (BTS, GINA, ATS, Monash, NAEPP, Singapore & New Zealand) to August 2013.Inclusion Criteria - Qualitative, quantitative or mixed methods research with primary focus on identifying explanations for barriers and/or facilitators to asthma management in South Asian children aged 0-18 years with diagnosed/suspected asthma and/or carers and/or healthcare professionals.Data Extraction - Three authors independently reviewed, selected & extracted eligible articles with disagreements resolved by research team discussion. RESULTS 15 studies encompassing 25,755 children, 18,483 parents/carers and 239 healthcare professionals were included. Barriers and explanatory factors identified were:1. Lack of asthma knowledge in families and healthcare professionals.2. Under-use of preventer medications.3. Non-acceptance/denial of asthma.4. Over-reliance on Emergency Department management.5. Communication problems.6. Non-adherence to medication.7. Use of complementary therapies.Little facilitators regarding asthma management were identified. CONCLUSIONS Several key issues were identified as likely to be ethnic-specific to South Asian families, rather than a reflection of minority status: impact of parental and professional knowledge and beliefs, health service utilisation pattern explanations and the impact of prejudice and stigmatisation. Other explanations such as language barriers are not strictly ethnic specific but instead reflect a minority position.Further research is required to identify why barriers exist, the mechanisms by which they impact on asthma management and how they can be overcome. Furthermore, understanding the difference between barriers and explanations that are ethnic-specific and those that are related to being a minority will enable the application of generic system-wide interventions where ethnicity is not the issue and ethnically-tailored interventions where needed.
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Affiliation(s)
- Monica Lakhanpaul
- General and Adolescent Paediatrics Unit, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Deborah Bird
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Logan Manikam
- Department of Primary Care and Public Health Sciences, 5th Floor, Capital House, 42 Weston Street, Guy’s, London SE1 3QD, UK
| | - Lorraine Culley
- School of Applied Social Sciences, De Montfort University, The Gateway, Leicester LE1 9BH, UK
| | - Gill Perkins
- Canterbury Christ Church University, North Holmes Road, Canterbury Kent CT1 1QU, UK
| | - Nicky Hudson
- School of Applied Social Sciences, De Montfort University, The Gateway, Leicester LE1 9BH, UK
| | - Joanne Wilson
- Leicester Children’s Community Services, Bridge Park Plaza, Bridge Park Road, Thurmaston, Leicester LE4 8PQ, UK
| | - Mark Johnson
- Mary Seacole Research Centre, De Montfort University, The Gateway, Leicester LE1 9BH, UK
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Cantarero-Arévalo L, Ersbøll AK, Holstein BE, Andersen A, Kaae S, Hansen EH. Ethnic and migrant differences in the use of anti-asthmatic medication for children: the effect of place of residence. Pharmacoepidemiol Drug Saf 2013; 23:95-104. [PMID: 24395546 DOI: 10.1002/pds.3541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/20/2013] [Accepted: 09/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ethnic differences in the use of anti-asthmatic medication have been reported, with ethnic minorities being at a higher risk of suboptimal asthma control. As contextual socioeconomic characteristics may play a role, we analysed whether ethnic differences in the use of anti-asthmatic medication among children residing in the Capital Region of Denmark varied by place of residence. METHODS Data were obtained from the Danish Civil Registration System, the Central Taxpayers' Register and the Danish National Prescription Register and were linked at the individual level. Population used was the entire child population in the Capital Region from 0 to 17 years old in 2008 (n = 342,403). Use of anti-asthma medicine was defined as at least one prescription having been filled in 2008. The analyses included multiple multilevel logistic regression models. RESULTS Children living in low-income places of residence had lower odds of being prescribed preventive anti-asthmatics compared with children living in higher-income places of residence [odds ratio (OR) = 0.87, 95% confidence interval (CI) 0.84-0.91]. Immigrant children had the lowest OR of being prescribed anti-asthmatics medication, both relief (OR = 0.50, 95% CI 0.20-0.77) and preventive (OR = 0.47, 95% CI 0.24-0.82) compared with ethnic Danes. Similar associations were found among descendants of immigrant children (OR for preventive medication = 0.70, 95% CI 0.62-0.78). Place of residence contributed to but did not account for the ethnic differences in the use of anti-asthmatic medication. CONCLUSIONS Ethnic differences in the use of anti-asthmatic medication were documented, and they cannot be explained by socioeconomic characteristics of place of residence. The lower prevalence of anti-asthmatic medication among ethnic minority children suggests poor asthma management control.
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Affiliation(s)
- Lourdes Cantarero-Arévalo
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Cantarero-Arévalo L, Holstein BE, Andersen A, Kaae S, Nørredam M, Hansen EH. Inequalities in asthma treatment among children by country of birth and ancestry: a nationwide study in Denmark. J Epidemiol Community Health 2013; 67:912-7. [PMID: 23814271 DOI: 10.1136/jech-2012-202135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Investigations in several Western countries have reported ethnic differences in asthma prevalence and treatment among children and in some countries these differences are increasing. The aim of this study was to analyse whether there are inequalities in asthma treatment by country of birth and ancestry among children residing in Denmark, and whether this potential association may vary between different household income groups. METHODS Data were obtained by linking the Danish Civil Registration System, the Central Taxpayers' Register and the Danish National Prescription Register. POPULATION the entire population of children in Denmark from 0 to 17 years of age in 2008 (n=1 209 091). Information on asthma treatment was obtained from the National Prescription Register. The analyses included multiple logistic regression models stratified by household income. RESULTS Compared with ethnic Danes, immigrant children had the lowest OR for redeeming a prescription for asthma medication, both relief (OR 0.37; 95% CIs, 0.20 to 0.68) and preventive (OR 0.37; (0.22 to 0.59)). Similar associations were found among descendant children (OR for relief treatment 0.82 (0.79 to 0.89) and for preventive treatment 0.68 (0.61 to 0.75)). The pattern of the association remained after stratifying for household income. CONCLUSIONS We found that, inequalities that cannot be explained by household income alone exist in treatments to prevent asthma as well as to relieve symptoms in children residing in Denmark, by country of birth and ancestry. The difference between immigrants and descendants may indicate that unfamiliarity with the Danish healthcare system is a contributory cause of the inadequate treatment of asthma.
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Affiliation(s)
- Lourdes Cantarero-Arévalo
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, , Copenhagen, Denmark
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Jephcote C, Chen H. Geospatial analysis of naturally occurring boundaries in road-transport emissions and children's respiratory health across a demographically diverse cityscape. Soc Sci Med 2013; 82:87-99. [DOI: 10.1016/j.socscimed.2013.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 01/02/2013] [Accepted: 01/24/2013] [Indexed: 11/28/2022]
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Leong AB, Ramsey CD, Celedón JC. The challenge of asthma in minority populations. Clin Rev Allergy Immunol 2013; 43:156-83. [PMID: 21538075 DOI: 10.1007/s12016-011-8263-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The burden and disparity of asthma in race/ethnic minorities present a significant challenge. In this review, we will evaluate data on asthma epidemiology in minorities, examine potential reasons for asthma disparities, and discuss strategies of intervention and culturally sensitive care.
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Affiliation(s)
- Albin B Leong
- Pediatric Pulmonology and Allergy, Roseville Kaiser Medical Center, 1600 Eureka Road, Roseville, CA 95661, USA.
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12
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Bialostozky A, Barkin SL. Understanding sibilancias (wheezing) among Mexican American parents. J Asthma 2012; 49:366-71. [PMID: 22352849 DOI: 10.3109/02770903.2012.660298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Asthma is one of the most common pediatric chronic diseases in the United States; however, prevalence varies across Latino ethnicities, such as Mexican Americans (MAs). Linguistic and cultural issues may contribute to difficulties in diagnosis. METHODS We conducted a qualitative study to assess the comprehension of common words used in a validated asthma questionnaire. The study sample consisted of 40 MA Spanish-speaking parents of 2- to 18-year-old children, with and without asthma, at a community health clinic. RESULTS Regardless of their child's asthma status, the majority of parents (12 [80%] with non-asthmatic children; 16 [64%] with asthmatic children) did not understand common Spanish words used in clinical settings to identify asthma (e.g., wheezing and whistling). Instead, parents used physical symptoms and sounds to describe asthma. CONCLUSION This exploratory study demonstrates MA parents' limited comprehension of common words used in clinical settings to identify asthma. Future research should examine tools that incorporate visual and auditory descriptions of asthma.
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Affiliation(s)
- Adriana Bialostozky
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232-9225, USA.
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Jephcote C, Chen H. Environmental injustices of children's exposure to air pollution from road-transport within the model British multicultural city of Leicester: 2000-09. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 414:140-151. [PMID: 22154180 DOI: 10.1016/j.scitotenv.2011.11.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/10/2011] [Accepted: 11/14/2011] [Indexed: 05/31/2023]
Abstract
The significant contribution of road-transport to air pollution within the urban arena is widely acknowledged, and traditionally explored in relation to health outcomes across a temporal scale. However, the structure of the urban environment is also of importance in dictating the existence of extremely variable traffic pollutant levels, which often tend to be linked with social disparities. Nevertheless 'Environmental Justice' studies have rarely tackled the adverse health implications of exposures from mobile sources (Chakraborty, 2009), or have applied statistical techniques that are appropriate for such spatial data (Gilbert and Chakraborty, 2011). This article addresses these gaps by spatially examining the distribution of respiratory hospitalisation incidents of children aged 0-15 years in relation to social circumstances and residential exposures of annual PM(10) road-transport emissions within Leicester during 2000-09. Continuing upon the theme of 'Environmental Justice', the research explores the intra-urban spatial distribution of those who produce and residentially experience the majority of road-transport emissions. The findings indicate significant global relationships to exist between children's hospitalisation rates and social-economic-status, ethnic minorities, and PM(10) road-transport emissions within Leicester. Local Indicators of Spatial Association (LISA) and Geographically Weighted Regression (GWR) identified important localised variations within the dataset, specifically relating to a double-burden of residentially experienced road-transport emissions and deprivation effecting inner city children's respiratory health. Furthermore, affluent intra-urban communities tended to contribute the highest levels of emission from private transport, while residentially experiencing relatively low exposure of transport emissions. This would suggest that environmental injustices prevail across the model British multicultural city of Leicester.
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Affiliation(s)
- Calvin Jephcote
- Institute for Transport Studies, University of Leeds, Leeds LS2 9JT, United Kingdom.
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14
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Curtis-Tyler K. Levers and barriers to patient-centred care with children: findings from a synthesis of studies of the experiences of children living with type 1 diabetes or asthma. Child Care Health Dev 2011; 37:540-50. [PMID: 21143267 DOI: 10.1111/j.1365-2214.2010.01180.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The last 50 years have seen a sea change in approaches to health care with children, from a time when children were routinely separated from parents while in hospital, to current recognition of the importance of placing the experiences of children and their families at the heart of care. Yet, there is a gap in the evidence about how children's involvement might be best achieved.This study aimed to synthesize findings of children's experiences of long-term illness and, from this, to identify levers and barriers to patient-centred care with children. METHODS A synthesis of studies of the experiences of children living with type 1 diabetes or asthma. DATA SOURCES Eight health and social care databases, bibliography searches and consultation with field experts and first authors of included studies. ELIGIBILITY CRITERIA Qualitative studies with children 10 years (mean) and younger on their experiences of living with type 1 diabetes or asthma. MAIN RESULTS Findings suggest key 'levers' to patient-centred care with children include: (1) engagement with children's expertise about their own lives: their personal and social experiences of their care, including how these are affected by their relative lack of power in some settings; (2) exploring children's understandings and preferences in terms of their physical sensations and day-to-day experiences; (3) willingness to find resources to engage with even the youngest children; (4) avoiding age-based assumptions about children's contributions to their care. DISCUSSION AND CONCLUSIONS Action on the above 'levers' may present a range of challenges in healthcare settings not least because it represents a move away from medicine's historical focus on children's developing competencies to engage rather with children's social realities from the earliest ages.
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Affiliation(s)
- K Curtis-Tyler
- School of Community and Health Sciences, City University, London, UK.
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15
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Paul IM, Maselli JH, Hersh AL, Boushey HA, Nielson DW, Cabana MD. Antibiotic prescribing during pediatric ambulatory care visits for asthma. Pediatrics 2011; 127:1014-21. [PMID: 21606155 DOI: 10.1542/peds.2011-0218] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE National guidelines do not recommend antibiotics as an asthma therapy. We sought to examine the frequency of inappropriate antibiotic prescribing during US ambulatory care pediatric asthma visits as well as the patient, provider, and systemic variables associated with such practice. PATIENTS AND METHODS Data from the National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Survey were examined to assess office and emergency-department asthma visits made by children (aged < 18 years) for frequencies of antibiotic prescription. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to assess the presence of coexisting conditions warranting antibiotics. Multivariable logistic regression models assessed associations with the prescription of antibiotics. RESULTS From 1998 to 2007, an estimated 60.4 million visits occurred for asthma without another ICD-9 code justifying antibiotic prescription. Antibiotics were prescribed during 16% of these visits, most commonly macrolides (48.8%). In multivariate analysis, controlling for patient age, gender, race, insurance type, region, and controller medication use, systemic corticosteroid prescription (odds ratio [OR]: 2.69 [95% confidence interval (CI): 1.68-4.30]) and treatment during the winter (OR: 1.92 [95% CI: 1.05-3.52]) were associated with an increased likelihood of antibiotic prescription, whereas treatment in an emergency department was associated with decreased likelihood (OR: 0.48 [95% CI: 0.26-0.89]). A second multivariate analysis of only office-based visits demonstrated that asthma education during the visits was associated with reduced antibiotic prescriptions (OR: 0.46 [95% CI: 0.24-0.86]). CONCLUSIONS Antibiotics are prescribed during nearly 1 in 6 US pediatric ambulatory care visits for asthma, ~ 1 million prescriptions annually, when antibiotic need is undocumented. Additional education and interventions are needed to prevent unnecessary antibiotic prescribing for asthma.
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Affiliation(s)
- Ian M Paul
- Department of Pediatrics, HS83, Penn State College of Medicine, Hershey, PA 17033, USA.
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16
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El-Sayed AM, Scarborough P, Galea S. Ethnic inequalities in obesity among children and adults in the UK: a systematic review of the literature. Obes Rev 2011; 12:e516-34. [PMID: 21348920 DOI: 10.1111/j.1467-789x.2010.00829.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ethnic minority groups are growing as a proportion of the British population. Although disparate, literature suggests inequalities in obesity risk within and among ethnic minority groups relative to Caucasians in the UK. We summarize and appraise the existing peer-reviewed literature about the prevalence and determinants of obesity among ethnic minority groups relative to Caucasians among children and adults in the UK. There was no consensus about obesity prevalence relative to Caucasians among South Asian or Black children or among South Asian adults relative to Caucasians. Black adults generally had higher risk for obesity than Caucasians. Both Chinese children and adults had lower risk for obesity than Caucasians. Few studies have considered differences in the aetiology of obesity by ethnicity. The lack of consensus regarding obesity risk among large ethnic minority groups relative to Caucasians in the UK, and the paucity of studies concerned with differences in obesity aetiology by ethnicity warrant further research in this area. Certain obesity metrics may bias obesity prevalence among particular ethnic groups relative to Caucasians. We summarize key methodological limitations to the current literature and suggest avenues for future research.
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Affiliation(s)
- A M El-Sayed
- Department of Public Health, University of Oxford, Oxford, UK.
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17
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Griffiths C, Ahmed S, Ahmed S, Nandy S, Abrams C, Meadows K, Foster G. Using health-related quality of life measures in minority ethnic groupsAn approach to translating measures into Bengali (Sylheti). Eur J Gen Pract 2009. [DOI: 10.3109/13814780009094319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Ginsberg D. An unidentified monster in the bed--assessing nocturnal asthma in children. Mcgill J Med 2009; 12:31-8. [PMID: 19753285 PMCID: PMC2687912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nocturnal asthma (NA) is increasing in prevalence, affecting millions of people worldwide. In addition to being associated with increased mortality, NA is associated with a decreased quality of life. NA associated sleep disturbances and increased daytime sleepiness are especially important in children due to the accompanying behavioral and developmental difficulties. As diurnal spirometry is not a practical tool for the diagnosis and monitoring of NA, self or parental reports are used. Children underreport and underestimate their NA symptoms and parents are not fully aware of their child's NA indicators. In addition, there is the lack of physician familiarity regarding the assessment and treatment of NA. Therefore, NA is chronically underreported. The development of a non-invasive, objective, home-based diagnostic tool is crucial in diagnosing and monitoring children with NA. The presence of wheeze during sleep has been successfully employed as a tool to measure NA in children. This review discusses the increasing prevalence of NA, current diagnostic tools and the consequences of undiagnosed NA in children. In conclusion, this paper suggests that an automated wheeze detective device is an objective and practical tool to aid the diagnosis and monitoring of NA.
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Affiliation(s)
- Darrell Ginsberg
- To whom correspondence should be addressed: Darrell Ginsberg, Department of Cellular Biology and Anatomy, Technion – Israel Institute of Technology, Faculty of Medicine Rappaport Building, 7 Rehov Efron, Bat Galim, Haifa, E-mail:
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19
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Kuehni CE, Strippoli MPF, Low N, Brooke AM, Silverman M. Wheeze and asthma prevalence and related health-service use in white and south Asian pre-schoolchildren in the United Kingdom. Clin Exp Allergy 2008; 37:1738-46. [PMID: 18028098 DOI: 10.1111/j.1365-2222.2007.02784.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidemiological data for south Asian children in the United Kingdom are contradictory, showing a lower prevalence of wheeze, but a higher rate of medical consultations and admissions for asthma compared with white children. These studies have not distinguished different asthma phenotypes or controlled for varying environmental exposures. OBJECTIVE To compare the prevalence of wheeze and related health-service use in south Asian and white pre-schoolchildren in the United Kingdom, taking into account wheeze phenotype (viral and multiple wheeze) and environmental exposures. METHODS A postal questionnaire was completed by parents of a population-based sample of 4366 white and 1714 south Asian children aged 1-4 years in Leicestershire, UK. Children were classified as having viral wheeze or multiple trigger wheeze. RESULTS The prevalence of current wheeze was 35.6% in white and 25.5% in south Asian 1-year-olds (P<0.001), and 21.9% and 20.9%, respectively, in children aged 2-4 years. Odds ratios (ORs) (95% confidence interval) for multiple wheeze and for viral wheeze, comparing south Asian with white children, were 2.21 (1.19-4.09) and 1.43 (0.77-2.65) in 2-4-year-olds after controlling for socio-economic conditions, environmental exposures and family history. In 1-year-olds, the respective ORs for multiple and viral wheeze were 0.66 (0.47-0.92) and 0.81 (0.64-1.03). Reported GP consultation rates for wheeze and hospital admissions were greater in south Asian children aged 2-4 years, even after adjustment for severity, but the use of inhaled corticosteroids was lower. CONCLUSIONS South Asian 2-4-year-olds are more likely than white children to have multiple wheeze (a condition with many features of chronic atopic asthma), after taking into account ethnic differences in exposure to some environmental agents. Undertreatment with inhaled corticosteroids might partly explain their greater use of health services.
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Affiliation(s)
- C E Kuehni
- Institute of Social and Preventive Medicine, Swiss Paediatric Respiratory Research Group, University of Bern, Bern, Switzerland.
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20
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Flores G, Tomany-Korman SC. The language spoken at home and disparities in medical and dental health, access to care, and use of services in US children. Pediatrics 2008; 121:e1703-14. [PMID: 18519474 DOI: 10.1542/peds.2007-2906] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Fifty-five million Americans speak a non-English primary language at home, but little is known about health disparities for children in non-English-primary-language households. Our study objective was to examine whether disparities in medical and dental health, access to care, and use of services exist for children in non-English-primary-language households. METHODS The National Survey of Childhood Health was a telephone survey in 2003-2004 of a nationwide sample of parents of 102 353 children 0 to 17 years old. Disparities in medical and oral health and health care were examined for children in a non-English-primary-language household compared with children in English- primary-language households, both in bivariate analyses and in multivariable analyses that adjusted for 8 covariates (child's age, race/ethnicity, and medical or dental insurance coverage, caregiver's highest educational attainment and employment status, number of children and adults in the household, and poverty status). RESULTS Children in non-English-primary-language households were significantly more likely than children in English-primary-language households to be poor (42% vs 13%) and Latino or Asian/Pacific Islander. Significantly higher proportions of children in non-English-primary-language households were not in excellent/very good health (43% vs 12%), were overweight/at risk for overweight (48% vs 39%), had teeth in fair/poor condition (27% vs 7%), and were uninsured (27% vs 6%), sporadically insured (20% vs 10%), and lacked dental insurance (39% vs 20%). Children in non-English-primary-language households more often had no usual source of medical care (38% vs 13%), made no medical (27% vs 12%) or preventive dental (14% vs 6%) visits in the previous year, and had problems obtaining specialty care (40% vs 23%). Latino and Asian children in non-English-primary-language households had several unique disparities compared with white children in non-English-primary-language households. Almost all disparities persisted in multivariable analyses. CONCLUSIONS Compared with children in English-primary-language households, children in non-English-primary-language households experienced multiple disparities in medical and oral health, access to care, and use of services.
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Affiliation(s)
- Glenn Flores
- University of Texas Southwestern Medical Center, Division of General Pediatrics, Department of Pediatrics, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
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21
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Urbanus-van Laar JJN, de Koning JS, Klazinga NS, Stronks K. Suboptimal asthma care for immigrant children: results of an audit study. BMC Health Serv Res 2008; 8:22. [PMID: 18218104 PMCID: PMC2254382 DOI: 10.1186/1472-6963-8-22] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 01/24/2008] [Indexed: 11/21/2022] Open
Abstract
Background Little is known on the scope and nature of ethnic inequalities in suboptimal asthma care for children. This study aimed to assess (1) ethnic differences in suboptimal asthma care for children with an asthma exacerbation who consulted a physician, and (2) ethnic differences in the nature of suboptimal care. Methods All children aged 6–16 years who during a period of six months consulted the paediatric department of the Academic Medical Centre-University of Amsterdam or one of the six regional primary care centres with an asthma exacerbation were included. Clinical guidelines were systematically converted to review criteria following the strategy as proposed by the Agency for Health Care Policy and Research. Based upon these review criteria and their experience experts of two multidisciplinary panels retrospectively assessed the quality of care and its (possible) failure to prevent the occurrence of asthma exacerbation. Results Only a small number of children (n = 35) were included in the analysis as a result of which the ethnic differences in suboptimal care were not significant. However, the results do indicate immigrant children, in particular 'other non-Western' children (n = 11), more frequently to receive suboptimal care related to the asthma exacerbation when compared to ethnic Dutch children. Furthermore, we found the nature of suboptimal care to differ with under-prescribing in the 'other non-Western' group (n = 11), lack of information exchange between physicians in the Surinamese/Antillean group (n = 12) and lack of education, and counselling of patients and parents in the ethnic Dutch (n = 12) as the most relevant factor. Conclusion Ethnic inequalities in the scope and nature of suboptimal asthma care for children in the Netherlands seem to exist. For the non-western immigrant groups the results indicate the importance of the prescription behaviour of the medical doctor, as well as the supervision by one health care provider.
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22
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Smeeton NC, Rona RJ, Gregory J, White P, Morgan M. Parental attitudes towards the management of asthma in ethnic minorities. Arch Dis Child 2007; 92:1082-7. [PMID: 17284478 PMCID: PMC2066074 DOI: 10.1136/adc.2006.112037] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Children from Indian and Pakistani (South Asian) and black minority groups have relatively high rates of attendance at accident and emergency (A&E) departments and admissions to hospital in the UK. We examine parents' beliefs and management of childhood asthma that possibly contribute to their greater use of hospital services. DESIGN Questionnaire survey. SETTING Three London hospitals serving multicultural communities with a high proportion of South Asian subjects. PARTICIPANTS Parent(s) accompanying 150 children aged 3-9 years with asthma attending asthma clinics and A&E departments. MAIN OUTCOME MEASURES White, South Asian and "other" ethnic group parents were compared regarding their children's symptoms and asthma in relation to why their children had developed asthma, use of asthma treatments, views about the prognosis of their children's asthma, and their feelings associated with stigma. RESULTS South Asian more often than white parents stated that they did not give preventers to their children (odds ratio (OR) 0.30; 95% confidence interval (CI) 0.12 to 0.75), that most drugs were "addictive" (OR 3.89; 95% CI 1.47 to 10.27), and that medicines could do more harm than good (OR 3.19; 95% CI 1.22 to 8.34). South Asian and "other" ethnic groups were more reluctant to tell others about their children's asthma (OR 0.11; 95% CI 0.01 to 1.06 and OR 0.06; 95% CI 0.01 to 0.65, respectively). CONCLUSION Cultural perspectives related to ethnicity are key factors in the understanding of asthma management. Health staff should give high priority to eliciting parents' beliefs regarding management of their children's asthma.
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Affiliation(s)
- Nigel C Smeeton
- Division of Health and Social Care Research, King's College London, London, UK.
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23
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Panico L, Bartley M, Marmot M, Nazroo JY, Sacker A, Kelly YJ. Ethnic variation in childhood asthma and wheezing illnesses: findings from the Millennium Cohort Study. Int J Epidemiol 2007; 36:1093-102. [PMID: 17525072 DOI: 10.1093/ije/dym089] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is not clear how respiratory morbidity during early childhood varies across ethnic groups in the UK. This article seeks to determine whether asthma and wheeze illnesses during early childhood differ across ethnic groups and what factors explain observed differences. METHODS Data from the UK Millennium Cohort Study on 14,630 children were analyzed from the second sweep of interviews. Parental interviews were conducted when the cohort member was aged approximately 3(1/2) years. Data collected included the occurrence of asthma and wheezing symptoms, biological and socio-economic factors and markers of cultural tradition. RESULTS At age 3, 12.3% (n = 1,902) of children had ever had asthma and 20.0% (n = 3,030) had wheezed in the last 12 months. 18.2% of Black Caribbean children and 5.0% of Bangladeshi children reported ever asthma compared with 11.6% of White children. 25.5% of Black Caribbean children and 8.7% of Bangladeshi reported recent wheeze compared with 19.4% of White children. After adjustments, the disadvantage in asthma and recent wheeze for Black Caribbeans was mostly explained by socio-economic factors (adjusted odds ratios (OR) for asthma 1.42, 95% confidence interval (CI) 0.96-2.09; recent wheeze 1.18, 0.85-1.64). The Bangladeshi advantage lost statistical significance, mostly due to adjustment for markers of cultural tradition (adjusted OR for asthma 0.40, 95% CI 0.15-1.09; recent wheeze 0.44, 0.18-1.19). CONCLUSION Our results point to the need to locate child health within the unique context of each ethnic group and to recognize that potential explanations for observed differences do not necessarily hold for all groups.
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Affiliation(s)
- Lidia Panico
- Department of Epidemiology & Public Health, University College London, London, UK
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24
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Bonner S, Matte T, Rubin M, Fagan JK, Ahern J, Evans D. Oral beta2-agonist use by preschool children with asthma in East and Central Harlem, New York. J Asthma 2007; 43:31-5. [PMID: 16448962 DOI: 10.1080/02770900500446989] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although studies have documented underuse of controller medications and overuse of short-acting inhaled ss(2)-agonist among children with persistent asthma in disadvantaged communities, the persistence of oral ss(2)-agonist use in pediatric practice has not been studied since inhaled short-acting ss(2)-agonists became widespread. We describe medications used to treat asthma among children 3 to 5 years of age at 10 Head Start and other subsidized preschool centers in East and Central Harlem, New York City. We interviewed 149 parents/guardians of children who were identified as having probable asthma based on physician's diagnosis, persistent symptoms, hospitalization, and medication use. We classified 86 of the 149 children (58%) as having current persistent asthma. Only 15 of them (17%) were reported to have used controller medications at least 5 days/week in the last 4 weeks-only 2 of whom used inhaled corticosteroids. By contrast, 53 children (62%) used oral ss(2)-agonist in the last 4 weeks, often (72%) in conjunction with nebulized or inhaled short-acting ss(2)-agonist. Use of oral ss(2)-agonist was associated with more severe symptoms. This study documents the continued widespread use of oral ss(2)-agonist for treatment of children in a low-income community with high prevalence of asthma.
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Affiliation(s)
- Sebastian Bonner
- Center for Urban Epidemiologic Studies, The New York Academy of Medicine, New York, NY 10029-5293
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25
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Forbes L, Harvey S, Newson R, Jarvis D, Luczynska C, Price J, Burney P. Risk factors for accident and emergency (A&E) attendance for asthma in inner city children. Thorax 2007; 62:855-60. [PMID: 17456503 PMCID: PMC2094271 DOI: 10.1136/thx.2006.058362] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Inner city children make heavy use of accident and emergency (A&E) services for asthma. Developing strategies to reduce this requires a better understanding of the risk factors. METHODS A case-control study was carried out of children with asthma living in south-east London: 1018 children who attended A&E for asthma over 1 year and 394 children who had not attended A&E for asthma over the previous year. The main risk factors were socioeconomic status, home environment, routine asthma management and parents' psychological responses to and beliefs about the treatment of asthma attacks. RESULTS A&E attendance was more common in children living in poorer households. No associations were found with home environment or with measures of routine asthma care. Children who had attended outpatients were much more likely to attend A&E (odds ratio (OR) 13.17, 95% CI 7.13 to 24.33). Other risk factors included having a parent who reported feeling alone (OR 2.58, 95% CI 1.71 to 3.87) or panic or fear (OR 2.62. 95% CI 1.75 to 3.93) when the child's asthma was worse; and parental belief that the child would be seen more quickly in A&E than at the GP surgery (OR 2.48, 95% CI 1.62 to 3.79). Parental confidence in the GP's ability to treat asthma attacks reduced the risk of attending A&E (OR 0.30, 95% CI 0.17 to 0.54). CONCLUSIONS There is no evidence that passive smoking, damp homes or poor routine asthma care explains heavy inner city use of A&E in children with asthma. Reducing A&E use is unlikely to be achieved by improving these, but identifying appropriate settings for treating children with asthma attacks and communicating these effectively may do so.
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Affiliation(s)
- Lindsay Forbes
- Wandsworth Primary Care Trust, Springfield University Hospital, 61 Glenburnie Road, London SW17 7DJ, UK.
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26
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Wittich AR, Mangan J, Grad R, Wang W, Gerald LB. Pediatric asthma: caregiver health literacy and the clinician's perception. J Asthma 2007; 44:51-5. [PMID: 17365205 DOI: 10.1080/02770900601125672] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Health literacy was assessed in pediatric asthma caregivers attending a university-based clinic. The medical provider's perception of caregiver health literacy was also examined. Eighty-six percent of the caregivers had adequate health literacy, 4% and 10% had marginal and inadequate health literacy, respectively. Health literacy was significantly higher for caregivers who were younger (p = 0.039) and had a higher level of education (p = 0.037). An agreement analysis revealed moderate agreement between provider perception of caregiver's health literacy and measured health literacy (Kappa = 0.51). The results suggest that medical providers may not accurately assess caregivers' actual health literacy level.
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Affiliation(s)
- Angelina R Wittich
- School of Health Professions, Department of Critical Care/Lung Health Center, University of Alabama at Birmingham. Birmingham, Alabama 35233, USA
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27
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Abstract
The number of racial/ethnic minority children will exceed the number of non-Latino white children in the United States by 2030, but little is known about racial/ethnic disparities in patient safety, particularly when it comes to children. A literature review revealed several racial/ethnic disparities in pediatric patient safety. A new conceptual model is proposed for understanding racial/ethnic disparities in patient safety. Evidence suggests that improving patient safety for minority children could be achieved by routinely collecting and monitoring parental self-reported data on race/ethnicity, language, and English proficiency; enhancing the cultural competency of health care providers and staff; and providing adequate language services for all limited English-proficient patients and their families.
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Affiliation(s)
- Glenn Flores
- Center for the Advancement of Underserved Children, Department of Pediatrics, Medical College of Wisconsin and Children's Research Institute, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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Chauliac ES, Silverman M, Zwahlen M, Strippoli MPF, Brooke AM, Kuehni ACE. The therapy of pre-school wheeze: appropriate and fair? Pediatr Pulmonol 2006; 41:829-38. [PMID: 16847878 DOI: 10.1002/ppul.20450] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The current study aimed to assess prevalence and distribution of use of asthma medication for wheeze in pre-school children in the community. We sent a postal questionnaire to the parents of a random population-based sample of 4,277 UK children aged 1-5 years; 3,410 participated (children of south Asian decent were deliberately over-represented). During the previous 12 months, 18% of the children were reported to have received bronchodilators, 8% inhaled corticosteroids (ICS) and 3% oral corticosteroids. Among current wheezers these proportions were 55%, 25%, and 12%, respectively. Use of ICS increased with reported severity of wheeze, but did not reach 60% even in the most severe category. In contrast, 42% of children receiving ICS reported no or very infrequent recent wheeze. Among children with the episodic viral wheeze phenotype, 17% received ICS compared with 40% among multiple-trigger wheezers. Use of ICS by current wheezers was less common in children of South Asian ethnicity and in girls. Although a high proportion of pre-school children in the community used asthma inhalers, treatment seemed to be insufficiently adjusted to severity or phenotype of wheeze, with relative under-treatment of severe wheeze with ICS, especially in girls and South Asian children, but apparent over-treatment of mild and episodic viral wheeze and chronic cough.
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Affiliation(s)
- E S Chauliac
- Department of Social and Preventive Medicine, Swiss Paediatric Respiratory Research Group, University of Bern, Bern, Switzerland
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29
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Erhabor GE, Agbroko SO, Bamigboye P, Awopeju OF. Prevalence of asthma symptoms among university students 15 to 35 years of age in Obafemi Awolowo University, Ile-Ife, Osun State. J Asthma 2006; 43:161-4. [PMID: 16517434 DOI: 10.1080/02770900500499046] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Asthma continues to cause increasing morbidity and mortality among young adults in the developing world. There is scarcity of data on the prevalence of asthma among young Nigerian adults. METHODS We studied the prevalence of asthma among students (15-35 years of age) of the Obafemi Awolowo University using a standardized questionnaire. One thousand self-administered questionnaires were distributed; 903 were retrieved and analyzed (469 males, 434 females). Symptoms indicative of asthma were cough, chest tightness at rest and on exposure to irritants, and the presence of nocturnal symptoms. Students with three or more symptoms or who had a diagnosis of asthma were considered probable asthmatics and those with one or two symptoms as suspected asthmatics. Students in any of these two categories were defined as symptomatic respondents. RESULTS The 12-month prevalence of wheeze, night waking with cough, and chest tightness in the morning was 9.0% (n = 81) 9.4% (n = 85) and 8.0% (n = 72), respectively. One hundred and twenty-seven respondents (14.1%) comprising 49 males (10.4%) and 78 females (17.9%) had probable asthma. The remaining symptomatic respondents consisting of 20 males (4.3%) and 16 females (3.9%) had suspected asthma. Of these, only 32.5% (53/163) had been previously diagnosed and 22.1% were on occasional inhaled bronchodilator treatment. CONCLUSION These results indicate a relatively high prevalence of asthma among the students. A greater proportion of them had not been diagnosed and were not receiving proper treatment.
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Affiliation(s)
- G E Erhabor
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
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Kozyrskyj AL, Dahl ME, Ungar WJ, Becker AB, Law BJ. Antibiotic treatment of wheezing in children with asthma: what is the practice? Pediatrics 2006; 117:e1104-10. [PMID: 16740813 DOI: 10.1542/peds.2005-2443] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Antibiotics are not recommended for the treatment of wheezing in children with asthma, but little is known about their use. This study was undertaken to evaluate trends and determinants of antibiotic use in children with wheezing during the fiscal years 1995 through 2001. METHODS Using the population-based health care and prescription databases in Manitoba, Canada, this descriptive study examined time trends in antibiotic prescription use for wheezing episodes in a population of children with asthma. The likelihood of receiving an antibiotic prescription according to child and physician characteristics also was determined. Annual population-based rates of antibiotic prescriptions for wheezing episodes were modeled by age and antibiotic class, using general estimating equations. The odds ratio for receiving an antibiotic prescription according to child demographics and physician factors was determined from hierarchical linear modeling. RESULTS The antibiotic prescription rate for wheezing decreased by 28% from 708 prescriptions per 1000 children with asthma in 1995 to 511 prescriptions in 2001. Fifteen-fold increases in use were observed for broader spectrum macrolides in preschool children. Twenty-three percent of physician visits for wheezing resulted in an immediate antibiotic prescription, but this percentage increased to 64% for antibiotics that were received within 7 days of the episode. General practitioners prescribed antibiotics more often than did pediatricians. Physicians who were not trained in Canada or the United States were 40% more likely to prescribe antibiotics than their counterparts. CONCLUSIONS Antibiotic use for wheezing in children declined in the 1990s, but the increased use of broader spectrum macrolides has implications for antibiotic resistance. A link between antibiotic prescribing and physician specialty and location of training identifies opportunities for intervention.
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Affiliation(s)
- Anita L Kozyrskyj
- Faculty of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada.
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Akinbami LJ, Rhodes JC, Lara M. Racial and ethnic differences in asthma diagnosis among children who wheeze. Pediatrics 2005; 115:1254-60. [PMID: 15867032 DOI: 10.1542/peds.2004-0897] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Racial and ethnic disparities exist in reported childhood asthma prevalence, but it is unclear if disparities stem from true prevalence differences or a different likelihood of receiving a diagnosis from a health professional. Concern has been raised that asthma may be underdiagnosed, particularly among minority children who have more restricted access to high-quality health care. OBJECTIVE To examine racial/ethnic differences among currently symptomatic children in acquiring an asthma diagnosis to determine if relative underdiagnosis among minorities exists. Children for whom no symptoms were reported (a group that includes those with well-controlled symptoms) were excluded from the analysis. METHODS The 1999 National Health Interview Survey includes a nationally representative sample of children with reported wheezing symptoms. We included children 3 to 17 years old in the study and analyzed racial/ethnic differences in asthma diagnosis, controlling for young age, gender, parental education, single-parent household, central-city residence, region of residence, health insurance, having a usual place of care, and parent-reported severity of wheezing symptoms. RESULTS Among those reported to have wheezed in the past year (n = 946), 83% of Puerto Rican, 71% of non-Hispanic black, and 65% of Mexican children were diagnosed with asthma compared with 57% of non-Hispanic white children. Using non-Hispanic white children as the reference group, the approximate adjusted relative risk for physician diagnosis of asthma given wheezing in the past year was 1.43 (95% confidence interval [CI]: 1.04, 1.63) for Puerto Rican, 1.22 (95% CI: 1.03, 1.37) for non-Hispanic black, and 1.19 (95% CI: 0.94, 1.39) for Mexican children. Minority children were reported to have greater severity of wheezing symptoms. Even after accounting for this increased severity, children in racial and ethnic minority groups were as or more likely to have a reported asthma diagnosis than non-Hispanic white children. CONCLUSIONS Our findings do not provide evidence for the hypothesis that symptomatic minority children are underdiagnosed with asthma compared with non-Hispanic white children. To the contrary, among currently symptomatic children, minority children were more likely to be diagnosed than non-Hispanic white children even after accounting for the higher wheezing severity among minority children.
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Affiliation(s)
- Lara J Akinbami
- Infant, Child, and Women's Health Studies Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA.
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Netuveli G, Hurwitz B, Levy M, Fletcher M, Barnes G, Durham SR, Sheikh A. Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Lancet 2005; 365:312-7. [PMID: 15664226 DOI: 10.1016/s0140-6736(05)17785-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The frequency of asthma varies between countries, and may also vary between ethnic groups in more geographically confined areas. We sought evidence of such ethnic variations in the UK for asthma frequency, morbidity, and health-services use, and to understand possible reasons for any differences. METHODS We searched MEDLINE, EMBASE, CINAHL, PSYCHInfo, PREMEDLINE, HEALTHSTAR, Cambridge Register of Conference Abstracts, the Dissertation and Thesis Database, and the National Registry of Research. Additionally, we searched the bibliographies of reports identified and websites of health authorities, and contacted experts in this discipline. Our main outcomes were comparisons of asthma rate, morbidity, and health-services use. We did meta-analyses using random-effects models. FINDINGS 13 studies contained relevant data. All prevalence studies were of children and showed that south Asian children had a lower frequency of symptoms suggestive of asthma compared with black and white children (pooled rate of history of wheeze in the previous 12 months: south Asians 9.6% [95%CI 8.0-11.2%], black people 16.2% [12.8-19.6%], white people 14.6% [11.5-17.8%]). The pooled frequency of clinician-diagnosed asthma in children followed a similar pattern (south Asians 7.6% [3.7-11.4%], black people 15.0% [3.5-26.5%], white people 10.6% [4.6-16.7%]. However, relative to white people, the risk of admission for asthma in children and adults was higher for south Asians (odds ratio 2.9 [2.4-3.4]) and black people (2.1 [1.8-2.5]). INTERPRETATION The differences in admission are not explained by differences in asthma frequency between groups; they could relate to ethnic variations in asthma severity, differences in health-seeking behaviour, or difficulties in accessing high-quality primary care services.
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Arai L, Harding S. A review of the epidemiological literature on the health of UK-born black caribbeans. CRITICAL PUBLIC HEALTH 2004. [DOI: 10.1080/109581590410001725355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Flores G, Rabke-Verani J, Pine W, Sabharwal A. The importance of cultural and linguistic issues in the emergency care of children. Pediatr Emerg Care 2002; 18:271-84. [PMID: 12187133 DOI: 10.1097/00006565-200208000-00010] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rapid growth in the diversity of the US population makes it increasingly likely that emergency clinicians will encounter greater numbers of patients from different cultures, but little is known about the importance of culture and language in the emergency care of children. OBJECTIVE To conduct a critical review and synthesis of published studies on culture and language in the emergency care of children. METHODS PubMed was used to perform a literature search (using 17 search terms) of all articles on culture, language, and the emergency care of children published in English or Spanish from 1966 to 1999. RESULTS More than 2000 citations initially were identified; consensus review yielded 400 papers that were photocopied. A final database of 117 articles revealed the following: certain normative cultural values, such as the Navajo hozhooji (the importance of thinking and speaking positively), can have profound effects on informed consent and discussions of medical risk. For limited English proficient children and their families, studies document that medical interpreters frequently are not used, there is a lack of trained interpreters, there are more access barriers, and those who need but do not get interpreters have poor understanding of their diagnosis and treatment. Numerous folk illnesses, such as among Latinos, can affect care, because symptoms often overlap with important biomedical conditions, the first clinical contact may be with folk healers, and certain folk remedies are harmful or even fatal. Certain parent beliefs and practices can result in serious morbidity and fatalities (from lead poisoning, liver failure, and other causes), costly or unnecessary medical evaluations (eg, Fenugreek teas), and clinical findings easily confused with child abuse (eg, coining). Biased provider attitudes and practices can have profound clinical consequences, including ethnic disparities in prescriptions, analgesia, test ordering, sexual history taking, asthma care quality, and diagnostic evaluations. CONCLUSIONS Failure to appreciate the importance of culture and language in pediatric emergencies can result in multiple adverse consequences, including difficulties with informed consent, miscommunication, inadequate understanding of diagnoses and treatment by families, dissatisfaction with care, preventable morbidity and mortality, unnecessary child abuse evaluations, lower quality of care, clinician bias, and ethnic disparities in prescriptions, analgesia, test ordering, and diagnostic evaluations.
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Affiliation(s)
- Glenn Flores
- Center for the Advancement of Urban Children, Department of Pediatrics, Medical College of Wisconsin, and Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Ng Man Kwong G, Das C, Proctor AR, Whyte MKB, Primhak RA. Diagnostic and treatment behaviour in children with chronic respiratory symptoms: relationship with socioeconomic factors. Thorax 2002; 57:701-4. [PMID: 12149530 PMCID: PMC1746399 DOI: 10.1136/thorax.57.8.701] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The prevalence and severity of asthma is believed to increase with increasing socioeconomic deprivation. The relationship between asthma diagnosis, symptoms, diagnostic accuracy, and socioeconomic deprivation as determined by Townsend scores was determined in Sheffield schoolchildren. METHODS All 6021 schoolchildren aged 8-9 years in one school year in Sheffield were given a parent respondent survey based on International Survey of Asthma and Allergies in Childhood (ISAAC) questions. RESULTS 5011/6021 (83.2%) questionnaires were returned. Postcode data were available in 4131 replies (82.4%) and were used to assign a composite deprivation score (Townsend score). Scores were divided into five quintiles, with group 1 being least and group 5 being most deprived. A positive trend was observed from group 1 to group 5 for the prevalence of wheeze in the previous 12 months, wheeze attacks >or=4/year, nocturnal wheeze and cough (all p<0.001), cough and/or wheeze "most times" with exertion (p<0.03), current asthma (p<0.001), and significant asthma symptoms (p<0.001). No significant trend was observed for lifetime wheeze or attacks of speech limiting wheeze. There were no significant trends in the prevalence of current asthmatic children without significant symptoms (overdiagnosis) or children with significant asthma symptoms but no current asthma diagnosis (underdiagnosis) across the social groups. There was a significant negative trend in the ratio of asthma medication to asthma diagnosis from least to most deprived groups (p<0.001). CONCLUSIONS Asthma morbidity and severity increase according to the level of socioeconomic deprivation. This may be due to differences in environment, asthma management, and/or symptom reporting. Diagnostic accuracy does not vary significantly across deprivation groups but children living in areas of least deprivation and taking asthma medication are less likely to be labelled as having asthma, suggesting diagnostic labelling bias.
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Affiliation(s)
- G Ng Man Kwong
- Respiratory Medicine Unit, Division of Genomic Medicine, University of Sheffield Medical School, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
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Aspinall P, Anionwu E. The role of ethnic monitoring in mainstreaming race equality and the modernization of the NHS: A neglected agenda? CRITICAL PUBLIC HEALTH 2002. [DOI: 10.1080/09581590110113277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Cabana MD, Flores G. The role of clinical practice guidelines in enhancing quality and reducing racial/ethnic disparities in paediatrics. Paediatr Respir Rev 2002; 3:52-8. [PMID: 12065183 DOI: 10.1053/prrv.2002.0182] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Paediatricians believe that clinical practice guidelines (CPGs) can improve patient care but only when the CPGs are flexible, rigorously tested, effective, not used punitively and are motivated by desires to improve quality, not reduce costs. Paediatricians may avoid using CPGs because few have been subjected to rigorous evaluation to demonstrate improved quality and reduced costs. Effective physician adherence to a CPG can be viewed as a multi-step process with potential barriers at each step. Barriers to adherence can be classified as internal (lack of awareness, familiarity, agreement, self-efficacy, outcome expectancy regarding a given CPG and inability to overcome the inertia of current practice) or external (deficits in the required CPG implementation infrastructure). Effective interventions for overcoming barriers to CPG adherence can include multiple modes of disseminating CPG information to practitioners, continuing medical education, feedback to physicians and establishing a solid infrastructure for CPG implementation. Adherence to evidence-based asthma CPGs may be a potentially powerful tool for reducing or eliminating racial/ethnic disparities in asthma treatment because CPGs consist of strict, explicit protocols based on symptoms, not race, ethnicity or socioeconomic status.
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Affiliation(s)
- Michael D Cabana
- Division of General Pediatrics, University of Michigan Medical Center, Ann Arbor 48109-0456, USA.
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Smyth RL. Asthma: a major pediatric health issue. Respir Res 2002; 3 Suppl 1:S3-7. [PMID: 12119051 PMCID: PMC1866369 DOI: 10.1186/rr188] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2002] [Revised: 05/31/2002] [Accepted: 06/03/2002] [Indexed: 11/10/2022] Open
Abstract
The incidence, prevalence, and mortality of asthma have increased in children over the past three to four decades, although there has been some decline in the most recent decade. These trends are particularly marked and of greatest concern in preschool children. Internationally, there are huge variations among countries and continents, as demonstrated by the International Study of Asthma and Allergies in Childhood. In general, asthma rates were highest in English-speaking countries (UK, New Zealand, Australia, and North America) and some Latin American countries (Peru and Costa Rica), and lowest in South Korea, Russia, Uzbekistan, Indonesia, and Albania. There is currently no unifying hypothesis to explain these trends or any associated risk factors. Environmental factors that may lead to asthma include air pollution; genetic factors, the hygiene hypothesis, and lifestyle differences also play potentially causative roles. Asthma may develop as a result of persistent activation of the immune system alone or in combination with physiologic airway remodeling in early childhood. Further studies are needed to confirm this hypothesis.
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Affiliation(s)
- Rosalind L Smyth
- University of Liverpool, Institute of Child Health, Alder Hey Children's Hospital, Liverpool L12 2AP, UK.
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Cane R, Pao C, McKenzie S. Understanding childhood asthma in focus groups: perspectives from mothers of different ethnic backgrounds. BMC FAMILY PRACTICE 2001; 2:4. [PMID: 11667951 PMCID: PMC58588 DOI: 10.1186/1471-2296-2-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2001] [Accepted: 09/26/2001] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnosing childhood asthma is dependent upon parental symptom reporting but there are problems in the use of words and terms. The purpose of this study was to describe and compare understandings of childhood 'asthma' by mothers from three different ethnic backgrounds who have no personal experience of diagnosing asthma. A better understanding of parents' perceptions of an illness by clinicians should improve communication and management of the illness. METHOD Sixty-six mothers living in east London describing their ethnic backgrounds as Bangladeshi, white English and black Caribbean were recruited to 9 focus groups. Discussion was semi-structured. Three sessions were conducted with each ethnic group. Mothers were shown a video clip of a boy with audible wheeze and cough and then addressed 6 questions. Sessions were recorded and transcribed verbatim. Responses were compared within and between ethnic groups. RESULTS Each session, and ethnic group overall, developed a particular orientation to the discussion. Some mothers described the problem using single signs, while others imitated the sound or made comparisons to other illnesses. Hereditary factors were recognised by some, although all groups were concerned with environmental triggers. Responses about what to do included 'normal illness' strategies, use of health services and calls for complementary treatment. All groups were concerned about using medication every day. Expectations about the quality of life were varied, with recognition that restrictions may be based on parental beliefs about asthma, rather than asthma itself. CONCLUSION Information from these focus groups suggests mothers know a great deal about childhood asthma even though they have no personal experience of it. Knowledge of how mothers from these ethnic backgrounds perceive asthma may facilitate doctor - patient communication with parents of children experiencing breathing difficulties.
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Affiliation(s)
- Rachel Cane
- Respiratory Department, Queen Elizabeth Children's Services, Royal London Hospital, Whitechapel, London E1 1BB, UK
| | - Caroline Pao
- Respiratory Department, Queen Elizabeth Children's Services, Royal London Hospital, Whitechapel, London E1 1BB, UK
| | - Sheila McKenzie
- Respiratory Department, Queen Elizabeth Children's Services, Royal London Hospital, Whitechapel, London E1 1BB, UK
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Figueroa-Muñoz JI, Chinn S, Rona RJ. Association between obesity and asthma in 4-11 year old children in the UK. Thorax 2001; 56:133-7. [PMID: 11209102 PMCID: PMC1745999 DOI: 10.1136/thorax.56.2.133] [Citation(s) in RCA: 222] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is evidence of a positive association between asthma and obesity in adults and in children. We investigated, in a large sample of English and Scottish primary school children, whether there is a consistent association between fatness and asthma symptoms in Britain. METHODS A cross sectional analysis was made of 18 218 children aged 4-11 years who participated in the 1993 or 1994 surveys of the National Study of Health and Growth (NSHG). Children belonged either to English or Scottish representative samples, or an English inner city sample. Asthma attacks in the previous year, occasional wheeze, or persistent wheeze were the symptoms used in the analysis. Body mass index (BMI) and the sum of triceps and subscapular skinfolds converted to standard deviation scores (SDS) were used to assess levels of fatness. RESULTS A total of 14 908 children (81.8%) were included in the analysis. In the multiple logistic analysis BMI and asthma (asthma attacks or wheeze) were associated in the representative sample (OR for the comparison of the 10th and 90th centiles of BMI 1.28, 95% CI 1.11 to 1.48), but sum of skinfolds was unrelated to asthma symptoms in most analyses. The association between asthma and BMI was stronger in girls than in boys in the inner city sample, but less convincingly in the representative sample. CONCLUSIONS Levels of obesity are associated with asthma symptoms regardless of ethnicity. The association is more consistent for BMI than for sum of skinfolds, partly because obese children are more advanced in their maturation than other children. There is some evidence that, as in adults, the association is stronger in girls than in boys, but only in the multiethnic inner city sample.
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Affiliation(s)
- J I Figueroa-Muñoz
- Department of Public Health Sciences, King's College, 5th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK.
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Abstract
AIMS To investigate how parents report children's respiratory sounds on video compared to a clinical "gold standard". METHODS Five clinicians agreed on 10 video clips of children with audible breathing. These responses were the "gold standard". The clips were shown to parents of children: (a) with asthma/wheeze; (b) with other respiratory complaints; (c) without respiratory complaints. Parents were asked what they called the sounds, where they originated, and whether their own child made similar sounds. RESULTS A total of 190 parents took part. The "correct" labelling of wheeze was 59% (95% confidence interval 52 to 66%) and 47% (95% confidence interval 40 to 54%) for other sounds (stridor, snoring, stertor). Parents were better at locating both sounds than labelling. There were no differences between subject groups. There were more false positive responses to labelling and locating other sounds than for wheeze (27% v 8% and 33% v 10%). CONCLUSION Parents locate sounds better than describing them. At least 30% of all parents use other words for wheeze and 30% labelled other sounds as "wheeze". This could have important clinical implications.
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Affiliation(s)
- R S Cane
- Queen Elizabeth Children's Services, 2nd Floor, Fielden House, Stepney Way, Royal London Hospital, Whitechapel, London E1 1BB, UK
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Smith GD, Chaturvedi N, Harding S, Nazroo J, Williams R. Ethnic inequalities in health: A review of UK epidemiological evidence. CRITICAL PUBLIC HEALTH 2000. [DOI: 10.1080/09581590010005331] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Affiliation(s)
- R J Rona
- Department of Public Health Sciences, Guy's, King's and St Thomas' School of Medicine, Guy's Campus, 6th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK
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Moudgil H, Marshall T, Honeybourne D. Asthma education and quality of life in the community: a randomised controlled study to evaluate the impact on white European and Indian subcontinent ethnic groups from socioeconomically deprived areas in Birmingham, UK. Thorax 2000; 55:177-83. [PMID: 10679534 PMCID: PMC1745690 DOI: 10.1136/thorax.55.3.177] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Whether asthma morbidity in minority groups can be reduced by preventative health care measures delivered in the relevant ethnic dialects requires further evaluation. This study reports clinical outcomes and quality of life from a community based project investigating white European (W/E) and Indian subcontinent (ISC) ethnic groups with asthma living in deprived inner city areas of Birmingham, UK. METHODS Six hundred and eighty nine asthmatic subjects (345 W/E, 344 ISC) of mean (SD) age 34.5 (15) years (range 11-59) and mean forced expiratory volume in one second (FEV(1)) of 80% predicted were interviewed in English, Punjabi, Hindi, or Urdu. Subjects randomised to the active limb of a prospective, open, randomised, controlled, parallel group, 12 month follow up study underwent individually based asthma education and optimisation of drug therapy with four monthly follow up (active intervention). Control groups were seen only at the beginning and end of the study. Urgent or emergency interactions with primary and secondary health care (clinical outcomes) and both cross sectional and longitudinal data from an Asthma Quality of Life Questionnaire (AQLQ) were analysed. RESULTS Clinical outcomes were available for 593 subjects. Fewer of the active intervention group consulted their GP (41.8% versus 57.8%, odds ratio (OR) 0.52 (95% CI 0.37 to 0.74)) or were prescribed antibiotics (34.9% versus 51.2%, OR 0.51 (95% CI 0.36 to 0.72)), but by ethnicity statistically significant changes occurred only in the W/E group with fewer also attending A&E departments and requiring urgent home visits. Active intervention reduced the number of hospital admissions (10 versus 30), GP consultations (341 versus 476), prescriptions of rescue oral steroids (92 versus 177), and antibiotics (220 versus 340), but again significant improvements by ethnicity only occurred in the active W/E group. AQLQ scores were negatively skewed to the higher values; regression analysis showed that lower values were associated with ISC ethnicity. Longitudinal changes (for 522 subjects) in the mean AQLQ scores were small but statistically significant for both ethnic groups, with scores improving in the active and worsening in the control groups. CONCLUSIONS Active intervention only improved clinical outcomes in the W/E group. AQLQ scores, although lower in the ISC group, were improved by active intervention in both ethnic groups.
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Affiliation(s)
- H Moudgil
- Department of Thoracic Medicine, City Hospital NHS Trust, Birmingham, UK
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Yeatts K, Maier W, Shy C. Asthma inhaler use and barriers in a population-based sample of African-American and white adolescents. Ann Allergy Asthma Immunol 2000; 84:94-100. [PMID: 10674572 DOI: 10.1016/s1081-1206(10)62747-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is little information on inhaler medication and barriers to use among a population-based sample of adolescents and whether possible variations in asthma treatment by ethnic group exist. OBJECTIVE We describe the prevalence of inhaler use and identify barriers for proper use of asthma medication in a population-based sample of adolescents of which 34% are African-American. METHODS A cross-sectional survey using the ISAAC (International Survey of Asthma and Allergies in Children) questionnaire was conducted in a school population-based sample (n = 2056) of 13 to 14-year-old eight grade students in the Charlotte-Mecklenburg, North Carolina public school system. Questions were asked about symptom prevalence, asthma diagnosis, inhaler use, and barriers to care. RESULTS Fourteen percent of the children (296/2056) reported using an inhaler in the last 12 months with no differences among African-American children and white children. Twenty-six percent of inhaler users were not allowed to carry their medication on their person while at school. Girls were more likely to be allowed to carry their inhalers at school and diagnosed asthmatic girls had a higher prevalence of wheezing in the last year (47%) compared with diagnosed asthmatic boys (35%). Smoking prevalence was higher in inhaler users (26%) compared to the study population (19%). CONCLUSIONS Inhaler use is high in this population. Adolescents using inhalers need to reduce their smoking levels. Schools need to reevaluate their policies on the use of inhalers at school.
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Affiliation(s)
- K Yeatts
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, 27599-7400, USA.
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Duran-Tauleria E, Rona RJ. Geographical and socioeconomic variation in the prevalence of asthma symptoms in English and Scottish children. Thorax 1999; 54:476-81. [PMID: 10334999 PMCID: PMC1745501 DOI: 10.1136/thx.54.6.476] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND There has been controversy over the relation between poverty and asthma in the community. The aim of this analysis was to disentangle geographical and socioeconomic variation in asthma symptoms. METHODS The analysis is based on parental reports of symptoms from data collected in 1990 and 1991. Children aged 5-11 years from three populations (English representative sample, Scottish representative sample, and an English inner city sample) were included. Of 17 677 eligible children, between 14 490 (82.0%) and 15 562 (88.0%) children were available for analysis according to symptom group. RESULTS Wheezy symptoms were less prevalent in the Scottish sample than in the English samples and asthma attacks were most prevalent in the English representative sample. Asthma attacks were less prevalent in inner city areas than in the English representative sample (OR 0.79, 95% CI 0.66 to 0.95), but persistent wheeze and other respiratory symptoms were more prevalent (OR 1.95, 95% CI 1.65 to 2.32 and OR 1.67, 95% CI 1.52 to 1.84, respectively). The prevalence of persistent wheeze was higher in children whose father's social class was low and in those living in areas with a high Townsend score (an index of poverty) than in other children (p<0.001). Of the 14 areas with the highest Townsend score, 13 had an OR above 1 and six had an OR significantly higher than the reference area. CONCLUSIONS Persistent wheeze is more prevalent in poor areas than in less deprived areas. This may indicate that poverty is associated with severe asthma or that a high percentage of persistent asthma symptoms in inner city areas are unrecognised and untreated.
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Chew FT, Goh DY, Lee BW. Under-recognition of childhood asthma in Singapore: evidence from a questionnaire survey. ANNALS OF TROPICAL PAEDIATRICS 1999; 19:83-91. [PMID: 10605526 DOI: 10.1080/02724939992699] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In a recent study on the prevalence of childhood asthma and allergies using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires, 6238 Singapore school children in two age-groups, 6-7 years (n = 2030) and 12-15 years (n = 4208), were evaluated. Of the 1856 children who reported asthma-like symptoms (wheezing, exercise-wheezing, persistent nocturnal cough), 919 (49%) had not been diagnosed asthmatic. Of these undiagnosed children, 731 (39%) reported current symptoms of asthma. Under-recognition of asthma was more prevalent among those with persistent nocturnal cough and mild symptoms. In addition, the discordance between wheezing in the last 12 months and a diagnosis of asthma was significantly higher among the younger age-group (6-7 years), but exercise-induced wheezing was less recognized as a symptom of asthma among the older age-group (12-15 years). This study has shown that there is a substantial degree of under-recognition of asthma among school children in Singapore.
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Affiliation(s)
- F T Chew
- Department of Paediatrics, National University of Singapore, Republic of Singapore
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Burr ML, Anderson HR, Austin JB, Harkins LS, Kaur B, Strachan DP, Warner JO. Respiratory symptoms and home environment in children: a national survey. Thorax 1999; 54:27-32. [PMID: 10343627 PMCID: PMC1745333 DOI: 10.1136/thx.54.1.27] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Respiratory diseases are common in childhood and may lead to chronic disease in adult life; environmental factors probably play an important part in their causation. METHODS A survey of respiratory symptoms in children aged 12-14 years was conducted throughout Great Britain as part of the International Study of Asthma and Allergies in Childhood (ISAAC). Information was obtained on certain aspects of the home environment in order to assess their importance as risk factors. RESULTS The response rate was 79.3%, and 25,393 children in 93 schools participated. In a multiple regression analysis, wheeze was reported more often in nonmetropolitan areas and in association with active smoking, passive smoking, the presence of a furry pet, bottled gas, paraffin, and other unusual heating fuels; small regional differences persisted. Current smoking, previous smoking, and passive smoking accounted for 10.4%, 6.8%, and 6.5%, respectively, of wheezing in the past 12 months, and furry pets accounted for 5.0%. Cough and phlegm were associated with active and passive smoking and with the miscellaneous fuels; similar associations were found for rhinitis, but were less consistent for rhinitis occurring in spring and summer. Gas cooking showed little association with respiratory symptoms. CONCLUSIONS Passive as well as active smoking is an important cause of respiratory symptoms in adolescence. Pets seem to increase the risk of wheeze and rhinitis, and fumes from certain unusual heating fuels may have adverse effects. Home environment and geographical location have independent effects on the prevalence of respiratory symptoms.
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Affiliation(s)
- M L Burr
- Centre for Applied Public Health Medicine, University of Wales College of Medicine, UK
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Eccles M, Ford GA, Duggan S, Steen N. Are postal questionnaire surveys of reported activity valid? An exploration using general practitioner management of hypertension in older people. Br J Gen Pract 1999; 49:35-8. [PMID: 10622014 PMCID: PMC1313315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Postal questionnaire surveys are commonly used in general practice and often ask about self-reported activity. The validity of this approach is unknown. AIM To explore the criterion validity of questions asking about self-reported activity in a self-completion questionnaire. METHOD A comparison was made between (a) the self-reported actions of all general practitioner (GP) principals in 51 general practices randomly selected within the nine family health services authorities of the former northern regional health authority, and (b) the contents of the medical records (case notes and computerized records) of patients classified as hypertensive from a 1 in 7 random sample of all patients registered in these practices and aged between 65 and 80. Data were gathered from the GPs by self-completion postal questionnaires. Six comparisons were made for two groups of items: first, target and achieved blood pressure; secondly, patient's weight, smoking status, alcohol consumption, exercise and salt intake. The frequency with which the data items were recorded in patient records was compared with the GPs' self-reported frequency of performing the actions. RESULTS No relationship was found between achieved blood pressure and stated target levels. For each of the other actions, more than half of the responders reported that they usually or always performed the activity. For four of these (smoking, weight, alcohol and exercise), a significant association was noted, but the size of this varied considerably. CONCLUSIONS There is a variable relationship between what responders report that they do in self-completion questionnaires, and what they actually do as judged by the contents of their patients' medical records. In the absence of prior, knowledge of the validity of questions on reported activity, or of concurrent attempts to establish their validity, the questions should not be asked.
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Affiliation(s)
- M Eccles
- Centre for Health Services Research, University of Newcastle Upon Tyne.
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Gilthorpe MS, Lay-Yee R, Wilson RC, Walters S, Griffiths RK, Bedi R. Variations in hospitalization rates for asthma among black and minority ethnic communities. Respir Med 1998; 92:642-8. [PMID: 9659530 DOI: 10.1016/s0954-6111(98)90511-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In response to the introduction of ethnic monitoring within the U.K. hospital inpatient data set, this study investigates the variations in secondary healthcare utilization by Black and minority ethnic communities whose cause of admission is related to asthma. The study examines all residents of the West Midlands: over 5 million people, of whom 8.5% are from Black and minority ethnic groups. A retrospective study of 15,921 asthma-related hospital admissions, from 1 April 1995 to 31 March 1996, was carried out. Age-standardized admission rates were higher in all Black and minority ethnic groups studied than in the White group. There were elevated rates in Black children aged 5-14 years, and particular differences were observed for Indian and Bangladeshi men and women aged 65 years or over. Emergency admissions to hospital for asthma were strongly associated with patients' socioeconomic background but this was largely observed for Black and minority ethnic groups that also generally experience high levels of deprivation. The findings support previous studies which suggest that hospital utilization rates for asthma among people from Black and minority ethnic groups are high compared with the White group, despite little evidence in measured prevalence. This study suggests that ethnic background is more important in asthma admissions than deprivation, which raises serious concerns on the appropriateness and quality of asthma care for these patient groups within our society. Future studies need to examine pathways to care, that is the health-seeking behaviour of Black and minority ethnic groups, the type of treatment received at the primary care level and referral patterns to secondary care.
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Affiliation(s)
- M S Gilthorpe
- National Centre for Transcultural Oral Health, Eastman Dental Institute for Oral Care Sciences, London, U.K
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