呼吸道感染诊断和抗生素处方的种族差异

文献信息

中文摘要

背景： 非白人患者比白人患者更不可能因呼吸道感染（RTIs）被开具抗生素。我们的目标是了解这是否可以通过不同种族的RTI诊断类型差异来解释。
方法： 我们进行了一项观察性队列研究，对象是2016年至2022年间在俄亥俄州东北部克利夫兰诊所接受紧急护理并被诊断为RTI的成年人。我们使用混合效应逻辑回归，按患者种族（白人与非白人）分析抗生素处方，建立两个模型：1）不考虑RTI诊断类型，2）考虑诊断类型。我们使用混合效应逻辑回归，包括医生和个体患者作为随机效应，评估不同种族被诊断为鼻窦炎与未指定RTI的比值差异。最后，我们按诊断分层，评估不同种族被开具抗生素的比值。分析在就诊层面进行。
结果： 在100,052次就诊中，涉及62,972名独特患者（每位患者中位就诊次数为1），21%为鼻窦炎，30%为未指定RTI。84%的患者为白人，16%为非白人。在不控制诊断的模型中，与白人患者相比，非白人患者被开具抗生素的可能性显著更低（aOR：0.79；95%CI：0.76-0.82）。调整诊断后，非白人种族与抗生素处方之间的关联减弱但仍显著（aOR：0.91；95%CI：0.87-0.95）。与白人患者相比，非白人患者被诊断为鼻窦炎而非未指定RTI的可能性显著更低（aOR：0.61；95%CI：0.56-0.66）。非白人患者因鼻窦炎和未指定RTI被开具抗生素的可能性均显著低于白人患者。
结论： 鼻窦炎诊断的种族差异部分解释了非白人患者抗生素处方率较低的原因。

英文摘要

BACKGROUND: Non-White patients are less likely than White patients to be prescribed antibiotics for respiratory tract infections (RTIs). Our objective was to understand whether this could be explained by differences in RTI diagnosis type by race.
METHODS: We conducted an observational cohort study of adults receiving urgent care at Cleveland Clinic in Northeast Ohio who were diagnosed with an RTI between 2016 and 2022. We used mixed effects logistic regression of antibiotic prescription by patient race (White versus non-White) in two models: 1) not accounting for RTI diagnosis type, and 2) accounting for diagnosis type. We used mixed effects logistic regression, including physician and individual patient as random effects, to assess differences in the odds of being diagnosed with sinusitis versus unspecified RTI by race. Finally, we assessed odds of being prescribed an antibiotic by race, stratified by diagnosis. Analyses were conducted at the visit level.
RESULTS: Among 100,052 visits with 62,972 unique patients (median visits per patient was 1), 21% percent were for sinusitis and 30% were for unspecified RTI. Eighty-four percent of patients were White and 16% were non-White. In the model not controlling for diagnosis, compared to White patients, non-White patients were significantly less likely to be prescribed an antibiotic (aOR: 0.79; 95%CI:0.76-0.82). After adjusting for diagnosis, the association between non-White race and antibiotic prescription was weaker but still significant (aOR:0.91; 95%CI:0.87-0.95). Compared to White patients, non-White patients were significantly less likely to be diagnosed with sinusitis versus unspecified RTI (aOR:0.61; 95%CI:0.56-0.66). Non-White patients were significantly less likely to be prescribed antibiotics for sinusitis and unspecified RTI than White patients.
CONCLUSIONS: Racial differences in diagnosis of sinusitis partially explain lower rates of antibiotic prescription among non-White patients.