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Pongdee T, Brunner WM, Kanuga MJ, Sussman JH, Wi CI, Juhn YJ. Rural Health Disparities in Allergy, Asthma, and Immunologic Diseases: The Current State and Future Direction for Clinical Care and Research. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:334-344. [PMID: 38013156 PMCID: PMC11089647 DOI: 10.1016/j.jaip.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/06/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
Rural health disparities are well documented and continue to jeopardize the long-term health and wellness for the millions of individuals who live in rural America. The disparities observed between urban and rural residents encompass numerous morbidity and mortality measures for several chronic diseases and have been referred to as the "rural mortality penalty." Although the unmet health needs of rural communities are widely acknowledged, little is known about rural health disparities in allergies, asthma, and immunologic diseases. Furthermore, the intersection between rural health disparities and social determinants of health has not been fully explored. To achieve a more complete understanding of the factors that perpetuate rural health disparities, greater research efforts followed by improved practice and policy are needed that account for the complex social context within rural communities rather than a general comparison between urban and rural environments or focusing on biomedical factors. Moreover, research efforts must prioritize community inclusion throughout rural areas through meaningful engagement of stakeholders in both clinical care and research. In this review, we examine the scope of health disparities in the rural United States and the impact of social determinants of health. We then detail the current state of rural health disparities in the field of allergy, asthma, and immunology. To close, we offer future considerations to address knowledge gaps and unmet needs for both clinical care and research in addressing rural health disparities.
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Affiliation(s)
- Thanai Pongdee
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
| | - Wendy M Brunner
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, Cooperstown, NY
| | - Mansi J Kanuga
- Division of Allergic Diseases, Mayo Clinic Health System, Red Wing, Minn
| | | | - Chung-Il Wi
- Precision Population Science Lab, Mayo Clinic, Rochester, Minn; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | - Young J Juhn
- Precision Population Science Lab, Mayo Clinic, Rochester, Minn; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Office of Mayo Clinic Health System Research, Mayo Clinic Health System, Rochester, Minn.
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Hernández-Garduño E. Asthma mortality among Mexican children: Rural and urban comparison and trends, 1999-2016. Pediatr Pulmonol 2020; 55:874-881. [PMID: 31962009 DOI: 10.1002/ppul.24658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/09/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although there are more studies showing higher asthma prevalence in urban rather than rural zones, few assessed asthma mortality by zone in children. The objective of this study is to compare asthma mortality rates (AMR) by zone of residence of Mexican children. DESIGN Using national death certificate and population projections data, AMR were compared in children aged 0 to 14 years by gender, age group, and zone of residence from 1999 to 2016. AMR trends were calculated using Joinpoint regression. RESULTS Of the 680 823 deaths, 2464 (0.36%) were due to asthma. Asthma mortality was higher in rural (0.65%) than urban (0.26%) zones, P < .0001. Whole period AMR median was also higher in rural vs urban zones (0.6 vs 0.3, respectively), P < .05. The average annual percent change (AAPC) of AMR for the whole period was -5.1 in all children with a higher percent decrease in rural vs urban zones (girls' AAPC = -6.3 vs -4.1, respectively and boys' AAPC = -4.8 vs -4.2, respectively). AMR decreased in children aged 0 to 4 from both zones (rural's AAPC: girls = -7.9, boys = -5.2; urban's AAPC: girls = -5.1, boys = -5.4), P < .05. No trend was found in children aged 5 to 14. CONCLUSIONS Asthma mortality in Mexican children is higher in rural than urban zones. The decrease of mortality over time in early childhood is reassuring. More research is needed to determine reasons for higher mortality in rural Mexico and for the lack of a favorable decreasing trend in children aged 5 to 14 from both zones.
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Affiliation(s)
- Eduardo Hernández-Garduño
- Dirección de Administración y Desarrollo de Personal, Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), Toluca de Lerdo, Mexico
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Chang YL, Ko HK, Lu MS, Chou CL, Su KC, Hsu CC, Chou KT, Chen TJ, Perng DW, Chou YC. Independent risk factors for death in patients admitted for asthma exacerbation in Taiwan. NPJ Prim Care Respir Med 2020; 30:7. [PMID: 32193384 PMCID: PMC7081219 DOI: 10.1038/s41533-020-0164-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
The independent risk factors for death in patients admitted for asthma exacerbation have not been thoroughly investigated. This study aimed to investigate these independent risk factors and the relationship between mortality and the prescription patterns of anti-asthmatic medications in patients admitted for asthma exacerbation. Using a nested case-control design, we identified 267 cases (death after asthma admission) and 1035 controls (survival after asthma admission) from the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2010. Conditional logistic regressions were used to estimate the odds ratios (ORs) with 95% confidence intervals (CIs). We identified the independent risk factors for death as the comorbidities of pneumonia (aOR 3.82, 95% CI 2.41-6.05), genitourinary disease (aOR 1.75, 95% CI 1.17-2.62), septicemia (aOR 4.26, 95% CI 2.61-6.94), diabetes mellitus (aOR 2.10, 95% CI 1.30-3.38), arrhythmia (aOR 2.00, 95% CI 1.14-3.50), and a history of asthmatic hospitalization (aOR 4.48, 95% CI 2.77-7.25). Moreover, the use of short-acting β2-agonist (SABA) and the dosage of oral corticosteroids (OCSs) >70 mg prednisolone during previous hospitalization (all p < 0.05) and the dosage of OCSs ≥110 mg prednisolone/month (aOR 2.21, 95% CI 1.08-4.50) during outpatient treatment independently increased the risk of death. The inhaled corticosteroids (ICSs) ≥4 canisters/year (aOR 0.39, 95% CI 0.19-0.78) independently reduced the risk of death. Specific comorbidities, asthma severity, and prescription patterns of SABA, OCSs, and ICSs were independently associated with mortality in patients admitted for asthma exacerbation. These results can be utilized to help physicians identify asthmatic patients who are at a higher mortality risk and to refine the management of the condition.
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Affiliation(s)
- Yuh-Lih Chang
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Kuo Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Meng-Shui Lu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Lin Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Kang-Cheng Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chen Hsu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Ta Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yueh-Ching Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan.
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
- School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
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Bhargava S, Holla AD, Jayaraj BS, Praveena AS, Ravi S, Khurana S, Mahesh PA. Distinct asthma phenotypes with low maximal attainment of lung function on cluster analysis. J Asthma 2019; 58:26-37. [PMID: 31479309 DOI: 10.1080/02770903.2019.1658205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Asthma is a heterogeneous disease with varying clinical presentations, severity and ability to achieve asthma control. The present study aimed to characterize clinical phenotypes of asthma in an Indian cohort of subjects using a cluster analysis approach. METHODS Patients with confirmed asthma (N = 100) and at least 6-months of follow-up data, identified by retrospective chart review, were included in this study. Demographics, age at disease onset, disease duration, body mass index, serial spirometry and allergen sensitization were assessed. Asthma control was assessed prospectively using Global Initiative for Asthma and Asthma Control Test. R version 3.4.3 was used for statistical analysis. Ward's minimum-variance hierarchical clustering method was performed using an agglomerative (bottom-up) approach. To compare differences between clusters, analysis of variance using Kruskal-Wallis test (continuous variables) and chi-square test (categorical variables) was used. RESULTS Cluster analysis of 100 treatment-naive patients with asthma identified four clusters. Cluster 1, (N = 40), childhood onset of disease, normal body weight, equal gender distribution and achieved normal lung function. Cluster 2 (N = 16) included adolescent disease-onset, obese, majority males and had poor attainment of maximum lung functions. Cluster 3 (N = 20) were older, late-onset of disease, obese, majority male and had poor attainment of maximum lung function. Cluster 4 (N = 24) had adult-onset of disease, obese, predominantly female and achieved normal lung function. CONCLUSIONS In an Indian cohort of well-characterized patients with asthma, cluster analysis identified four distinct clinical phenotypes of asthma, two of which had poor attainment of maximum lung functions.
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Affiliation(s)
- Smriti Bhargava
- Department of Pulmonology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | | | - Biligere S Jayaraj
- Department of Pulmonology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | | | - Sreenivasan Ravi
- Department of Studies in Statistics, University of Mysore, Mysore, India
| | - Sandhya Khurana
- Division of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Padukudru A Mahesh
- Department of Pulmonology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
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